OSCE — Mitral Valve Prolapse · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Mitral Valve Prolapse.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Mitral valve prolapse (MVP) is the systolic billowing of one or both mitral leaflets above the mitral annulus into the left atrium, defined echocardiographically as leaflet displacement of more than 2 mm beyond the mitral annular plane in the parasternal long-axis view during systole. The underlying pathology is myxomatous degeneration of the leaflet (proteoglycan-rich matrix, fragmented collagen) with chordal elongation and often annular dilatation or mitral annular disjunction (MAD). MVP is the commonest primary valve abnormality in developed countries, with a population prevalence of 2 to 3 percent; in the Framingham offspring cohort it was 2.4 percent, and the age and sex distributions of those with prolapse matched those without, so the often-quoted 2:1 female predominance reflects referral series rather than the community. Clinically, two morphological phenotypes are recognised — fibroelastic deficiency (thin leaflets, focal P2 prolapse, chordal rupture, acute severe MR) and diffuse myxomatous Barlow's disease (multisegmental bileaflet billowing, dilated annulus, chronic severe MR). Most patients are asymptomatic with a mid-systolic click and late systolic murmur that moves earlier with Valsalva or standing and later with squatting; the station turns on grading the mitral regurgitation, recognising the arrhythmic phenotype, and knowing that endocarditis prophylaxis is not indicated for MVP.

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	Sudden syncope, cardiac arrest or polymorphic VT/VF in a young patient with MVP and MAD - arrhythmic MVP; secondary prevention with an ICD, treat the MAD and MR
Safety	New acute severe MR after chordal rupture - pulmonary oedema and cardiogenic shock; urgent repair, vasodilator and IABP bridge
Safety	New neurological deficit in MVP with AF - cardioembolic stroke; anticoagulate, rate or rhythm control, treat the MR
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.