()..

Valvular heart disease

Common valvular heart disease for OSCE Single valve disease

Mitral stenosis (MS)Mitral regurgitation (MR)Aortic stenosis (AS)Aortic regurgitation (AR)Tricuspid regurgitation (TR)

Common valvular heart disease for OSCE

DiseasePositionLocationStethoscopeMurmur RadiationMSApexBellLoud S1, OS, DRMNoMRApexDiaphragmPSMLt. axillaASAVA (2nd Rt ICS)DiaphragmClick, SEMCarotid a.ARErbs pointDiaphragmDBMNoTRTVA (LLSB)DiaphragmPSMNo

Scenario

:

(60 ) (25 )3. 1 (15 )

Skill

CompleteSequence Doctor-Patient relationship

Cardiovascular examination

() -

Peripheral Central (vascular) (Cardiac)

, neck vein engorgement, carotid artery radial pulse water hammer thrill ventricular heaving apex beatCardiovascular examination (1)

heart apex (MR) apex bell (MS) (AR) radiation carotid artery (AS)Cardiovascular examination (2)

Pitfall (skill)The most dangerous (1) 25 50

Pitfall (skill)The most dangerous (2) OSCE : skill evaluation > knowledge evaluation

Pitfall (skill), neck vein engorgement,

: Neck vein : -

:

3 important things to do

Not only to see or to say

Correct : sternocleidomastoid muscleIncorrect 2

carotid artery

Correct : 2

Incorrect

Radial pulse

water hammer

Pulse palpationWater hammer

thrill valvular area heaving LV RV heaving

Heaving palpationLV heavingRV heaving

Thrill palpation

Apex beat

Most of all : OK

Auscultation valvular areaSome : forget

Dont forget heart apex (MR)

apex bell (MS)

(AR)

radiation carotid artery (AS)

Doctor-Patient relationshipCommunication : OK But precordium !!! May be its not OK

The last recommendation

(finding & diagnosis)v.s.