"Cardio-vascular system"

MRCP-PACES 3oth November 2005

Station 3:
Cardio-vascular:

A middle-aged lady presented with reduced effort tolerance, I was asked to examine her cardio-vascular system. I started by examining the peripheries. I then noted patient had irregularly irregular pulse. What came to my mind were two differential diagnosis, either Mitral valve disease or ASD. Her apex beat was not displaced and was tapping in nature (very classical). There was parasternal heave. S1 and S2 were loud and there was a MDM over the apex. No other abnormal sound was heard. Examiner asked me what was the findings and I started presenting all the positive signs from the peripheries. I concluded as: "This patient has pure mitral stenosis, secondary to chronic rheumatic heart disease, complicated by atrial fibrillation and pulmonary hypertension; clinically she is not in cardiac failure and there is no stigmata of infective endocarditis". The examiner asked me whether there was any other murmur heard and I said no. Examiner did not probe further, so I presumed I was correct. They only questioned me on how to assess severity clinically.

Comment:

I was lucky because this case was quite straight forward.

Outcome: 4/3