MBChB Clinical Scenarios

Show Learning Points most relevant to Phase 1:

Valvular heart disease

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System

Progress Test Topic(s)
Cardiovascular

Description

A 38 year old Māori woman sees her GP because she is getting very short of breath, even at rest. On examination the GP hears a cardiac murmur. They ask you to listen and suggest a management plan.

Progress Test-Type Questions: Question 1 | Question 2

Applied Science for Medicine
   - Anatomy of the heart
   - Physiology of the cardiac cycle, how heart sounds are generated and hydrodynamics
   - Characterisation of systolic and diastolic murmurs, including grading
   - Pathology of different valvular lesions
   - Pathology of rheumatic heart disease

Clinical and Communication Skills
   - History from a patient with a murmur and determine functional status; consider risk factors for rheumatic fever
   - Examination of the cardiovascular system; recognise the common diastolic, systolic and continuous murmurs
   - Perform measurement of blood pressure and an ECG
   - Differential diagnosis of a murmur, including non-valvular causes
   - Indications for echocardiogram, dobutamine stress echocardiogram, angiogram
   - Management of valvular heart disease and indications for surgery
   - Management of non-valvular structural heart disease
   - Complications of valvular heart disease
   - Prognosis of valvular heart disease
   - Define Eisenmengers syndrome and how it arises

Personal and Professional Skills
- Importance of pre-conceptual counselling and interdisciplinary care during pregancy for women with heart disease

Hauora Māori
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) presenting with heart murmurs compared with non-Māori in New Zealand
   - Understanding of inequities in access to health services and quality of medical care for Māori including screening/prevention of rheumatic heart disease, and application of this to clinical decision making and management
   - Awareness of disproportionate impact of socioeconomic deprivation on incidence/outcomes of rheumatic heart disease for Māori, and appropriate response
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing rheumatic heart disease inequalities

Population Health
   - Epidemiology of structural heart disease
   - Rheumatic heart disease: high risk populations, risk factors for individuals
   - Prevention of rheumatic heart disease: potential strategies, proven interventions
   - Access to health services for diagnosis and treatment of valvular heart disease: promotion of prompt and effective care

Conditions to be considered relating to this scenario

Common
aortic stenosis, aortic regurgitation, flow murmur, mitral regurgitation, aortic sclerosis, mitral valve prolapse, tricuspid regurgitation, mitral stenosis, ventricular septal defect, ostium secundum and sinus venosus, atrial septal defect: ostium primum

Less common but 'important not to miss'
infective endocarditis, hypertrophic obstructive cardiomyopathy

Uncommon
pulmonary stenosis, pulmonary regurgitation, tricuspid stenosis, patent ductus arteriosus, tricuspid valve prolapse