MBBS OSCE · Cardiology
OSCE — Adult Congenital Heart Disease
Eight-minute OSCE station on Adult Congenital Heart Disease: 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 Adult Congenital Heart Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]
Clinical context
Adult congenital heart disease (ACHD) is the lifetime management of patients with structural heart disease present since birth who survive into adulthood. The commonest lesions encountered in adults are secundum atrial septal defect (ASD), repaired Tetralogy of Fallot (TOF), coarctation of the aorta, bicuspid aortic valve, Ebstein anomaly and the late consequences of atrial-switch (Mustard/Senning) or Fontan surgery. The central diagnostic skill is recognising an unrepaired shunt, the central decision is shunt closure before irreversible pulmonary vascular disease, and the irreversible end-stage of an uncorrected L-to-R shunt is Eisenmenger syndrome — pulmonary arterial hypertension (PAH) at or above systemic level with shunt reversal.[1]
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).[1][14]
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 | Central cyanosis, clubbing and exertional syncope in a patient with a known or s |
| Safety | Haemoptysis in Eisenmenger — potentially fatal; sit upright, avoid iatrogenic fl |
| Safety | Pregnancy in Eisenmenger, severe idiopathic PAH, severe mitral stenosis, severe |
| 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.[1]
References4ShowHide
- [1]Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease Eur Heart J, 2021.PMID 32860028
- [6]Galiè N, Beghetti M, Gatzoulis MA, et al. Bosentan therapy in patients with Eisenmenger syndrome Circulation, 2006.PMID 16801459
- [14]El Iskandarani M, Golamari R, Bettinotti BGM, et al. Pregnancy in patients with pulmonary hypertension J Thorac Dis, 2025.PMID 40809209
- [16]Gatzoulis MA, Till JA, Somerville J, Redington AN Mechanoelectrical interaction in tetralogy of Fallot Circulation, 1995.PMID 7600655