Heart Failure and Cardiomyopathies — WACS Viva & Clinical Scenarios (Cardiovascular Medicine)

Exam-style heart failure and cardiomyopathies viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 54-year-old hypertensive male presents with progressive breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea, and bilateral pedal swelling. Echocardiography demonstrates a dilated left ventricle with an ejection fraction of 28%. Formulate and defend an evidence-based guideline-directed medical therapy regimen, detailing the rationale, initiation sequence, monitoring parameters, and specific considerations for patients of African descent.
• SCENARIO 2: A 62-year-old female with ischaemic cardiomyopathy is brought to the emergency department in acute severe respiratory distress. Physical examination reveals cold extremities, peripheral cyanosis, blood pressure 82/50 mmHg, heart rate 118 beats per minute, elevated jugular venous pressure, and diffuse bilateral pulmonary crackles. Outline the haemodynamic classification, initial resuscitation, diagnostic workup, and pharmacological strategy for this presentation.
• SCENARIO 3: A 28-year-old primigravida presents at 6 weeks postpartum with new-onset NYHA Class IV heart failure. Transthoracic echocardiography reveals four-chamber dilatation, severe global hypokinesia, and a left ventricular ejection fraction of 24% without baseline cardiac disease. Discuss the diagnostic criteria, disease-specific pathophysiology, evidence-based pharmacotherapy including prolactin-inhibition protocols, and long-term reproductive counselling.
• SCENARIO 4: A 22-year-old male athlete collapses during competitive football and is successfully resuscitated from ventricular fibrillation. Transthoracic echocardiography reveals asymmetrical septal hypertrophy with a maximum wall thickness of 26 mm and a dynamic left ventricular outflow tract gradient of 48 mmHg at rest. Detail the sudden cardiac death risk stratification model, medical management, septal reduction indications, and family screening recommendations.
• SCENARIO 5: Differentiate between restrictive cardiomyopathy secondary to endomyocardial fibrosis and constrictive pericarditis in a West African clinical setting. Detail the pathophysiological differences, characteristic physical examination findings, echocardiographic and Doppler features, cardiac catheterisation haemodynamic profiles, and therapeutic approaches.