OSCE Patho station : Heart Failure

Section Description Mark

PLEASE ASK CANDIDATE THE FOLLOWING QUESTIONS (4-5 marks)
Question Describe what organ do you see? /6
1 ● Macroscopic cross section of the heart. (1)
● It can be seen that it is the heart due to the presence of the
valves, chordae tendinae, and the chambers of the heart can be
identified. (2)
What are the abnormalities seen?
● The specimen is abnormal due to the asymmetrical hypertrophy
of the ventricular tissue. (1)
● There is a narrowing the LV outlet. (1)
● The LV septum appears more thickened than the left lateral
wall. (1)

Question Compare the macroscopic and micoscopic features of HOCM and /4

2 LVH due to pressure loaded left ventricles (e.g HTN, AS):
o HOCM: Hypertrophy is asymmetrical; the septum is
disproportionately thicker than the LV anterior/lateral
wall. (1) The right ventricle may also be involved in the
hypertrophic process. (1)
o In LVH secondary to AS or HTN, the hypertrophy is
symmetrical / concentric . (1)
o In both types of hypertrophy, microscopically they are
similar with cardiomyocytes >40micrometers diameter.
(1)
Question List out 3 main types of cardiomyopathies and the difference in / 10
3 their pathophysiology and their effects on ejection fraction.
● Dilated
● Hypertrophic
● Restrictive (1)

Dilated:
● Impaired squeezing (0.5)
● Reduced ejection fraction (0.5)

Hypertrophic:
● Impaired filling (0.5)
● Ejection fraction normal (0.5)

Restrictive:
● Decreased preload (0.5)
● Ejection fraction normal (0.5)
2 causes of each:

● Dilated – impaired squeezing (systolic dysfunction) (1)

o Causes
▪ Idiopathic
▪ Alcoholism
▪ Peripartum
▪ Genetic
▪ Myocarditis
▪ Haemochromatosis
▪ Chronic anemia
▪ Doxorubicin
▪ Sarcoidosis
● Hypertrophic - impaired filling (diastolic dysfunction) (1)
o Causes
▪ Idiopathic
▪ Genetic
▪ Infants of diabetic mothers
▪ Storage diseases
● Restrictive – decreased preload (diastolic dysfunction) (1)
o Causes
▪ Idiopathic
▪ Amyloidosis
▪ Radiation-induced fibrosis

How to classify the severity of heart failure based on symptoms?

● NYHC (1)

Class Patient Symptoms

I No limitation of physical activity. Ordinary physical activity does not

cause undue fatigue, palpitation, dyspnea (shortness of breath).

II Slight limitation of physical activity. Comfortable at rest. Ordinary

physical activity results in fatigue, palpitation, dyspnea (shortness of
breath).

III Marked limitation of physical activity. Comfortable at rest. Less than

ordinary activity causes fatigue, palpitation, or dyspnea.

IV Unable to carry on any physical activity without discomfort.

 Symptoms of heart failure at rest. If any physical activity is
undertaken, discomfort increases.

(2)

OVERALL Pass Borderline Fail /20

ATTACHMENTS
Figure 1
Station 5:

You are required to interpret a pathology picture and

answer some questions. You are not allowed to go back
to the previous question along the way. You have 8
minutes to complete this station.

Pathology Gross Specimen