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Home / Station 27: Cardiovascular examination in heart failure

NAC OSCE preparation

Station 27: Cardiovascular examination in heart failure

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Cardiovascular examination in heart failure

11 minutes

Discipline: Physical Examination
Station type: Focused cardiovascular exam
Setting: Internal medicine ward

Your task

Perform a focused cardiovascular examination on this patient with dyspnea. State what you would look for but do not perform fundoscopy or intimate examination.

Information available at entry

HR 96/min regularBP 148/86 mm HgRR 22/minSpO₂ 93% room air

Coach prompt: Perform a systematic exam, identify congestion and present findings concisely.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 27 of 30

Standardized-patient profile

NameMr. Adrian Lee

Age69

Pronounshe/him

RolePatient

Demeanour: Comfortable at rest, mildly breathless when lying flat.

Opening statement: “I get short of breath and my ankles have become swollen.”

History and standardized-patient responses

Information if requested after exam

Candidate explores	Standardized-patient response
Symptoms	Orthopnea, paroxysmal nocturnal dyspnea and reduced exercise tolerance.
Pain	No current chest pain.
History	Prior anterior myocardial infarction and hypertension.

Physical findings

General: elevated work of breathing, bilateral ankle edema.
Pulse regular; warm peripheries.
JVP elevated approximately 5 cm above sternal angle at 45 degrees.
Displaced, diffuse apex beat.
S3 gallop; pansystolic murmur at apex radiating to axilla.
Bibasal fine crackles.
Mild tender hepatomegaly; sacral edema absent.

Examiner prompts

Summarize findings.

Signs of biventricular congestion: raised JVP, displaced apex, S3, functional mitral regurgitation, basal crackles and peripheral edema.

Likely diagnosis?

Decompensated heart failure, likely ischemic cardiomyopathy with possible mitral regurgitation.

Next steps?

Assess severity/precipitants, ECG, chest radiograph, labs, echocardiography and treat congestion while monitoring.

Differential diagnosis

Acute decompensated heart failure
Mitral regurgitation
Acute coronary syndrome
Arrhythmia
Renal/fluid overload
Pneumonia

Investigations

ECG and troponin when indicated
Chest radiograph
CBC, electrolytes, creatinine, liver tests and natriuretic peptide where used
Echocardiography
Search for ischemia, arrhythmia, infection and nonadherence

Management

Upright position and oxygen only if hypoxemic
Diuresis with monitoring
Treat precipitant
Consider vasodilator when appropriate
Daily weight, fluid balance, renal function and electrolytes
Escalate if shock or respiratory failure

Communication behaviours

Explain each maneuver
Maintain dignity and warmth
Ask about discomfort during positioning

Critical safety actions

Do not omit lung and volume-status examination
Recognize low perfusion/shock signs
Do not give routine oxygen when saturation is adequate

Model closing summary

The cardiovascular examination shows elevated JVP, a displaced diffuse apex, S3, apical pansystolic murmur, bibasal crackles and peripheral edema, consistent with decompensated congestive heart failure, likely on an ischemic background with mitral regurgitation. I would assess oxygenation and perfusion, investigate precipitants and ventricular/valvular function, and begin monitored decongestive treatment.

Common pitfalls

Listening through clothing
Calling JVP by visual guess without positioning
Failing to summarize severity
Treating before assessing stability

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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