MBBS OSCE · Cardiology
OSCE — Mitral Regurgitation
Eight-minute OSCE station on Mitral Regurgitation: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Mitral Regurgitation.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Mitral regurgitation (MR) is systolic backflow of blood from the left ventricle (LV) into the left atrium (LA) through an incompetent mitral valve. Chronic MR runs an asymptomatic compensated phase (LA and LV dilate, eccentric hypertrophy) before decompensation with dyspnoea, fatigue and atrial fibrillation. Acute MR (papillary-muscle or chordal rupture post-MI) presents as fulminant pulmonary oedema and cardiogenic shock. Cardinal sign: pansystolic murmur at the apex radiating to the axilla, soft S1, and a third heart sound. Diagnosis and grading are by echocardiography (EROA, regurgitant volume/fraction, vena contracta). Definitive treatment is mitral valve repair (preferred) or replacemen
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Acute severe MR post-MI with pulmonary oedema and shock - papillary muscle or ch |
| Safety | Severe chronic MR with EF under 60% or LVESD at least 40 mm - refer for valve su |
| Safety | New atrial fibrillation in severe MR - anticoagulate (CHA2DS2-VASc) and reassess |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.