MBBS OSCE · cardiology
OSCE — Restrictive Cardiomyopathy
Eight-minute OSCE station on Restrictive Cardiomyopathy: 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 Restrictive Cardiomyopathy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Restrictive cardiomyopathy (RCM) is the rarest of the three WHO cardiomyopathies, defined by non-compliant, stiff ventricles that resist filling in diastole, with reduced diastolic volume and preserved (or near-normal) systolic function, producing biventricular diastolic heart failure with bi-atrial enlargement. Leading cause in the developed world is cardiac amyloidosis (AL light-chain, and ATTR — wild-type/senile and hereditary variant); other causes are sarcoidosis, haemochromatosis, endomyocardial fibrosis (EMF) / Loffler endocarditis, radiation, carcinoid heart disease, glycogen storage diseases (Fabry, Pompe, Danon) and scleroderma. Presents with right-heart-failure signs (raised JVP,
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 | Elderly man with HFpEF, low ECG voltages, increased LV wall thickness and carpal |
| Safety | Patient over 60 with heart failure, raised JVP, macroglossia or periorbital purp |
| Safety | Bi-atrial enlargement with preserved EF and signs of right heart failure — restr |
| 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.