Valvular, Pericardial, and Congenital Heart Diseases — WACS Viva & Clinical Scenarios (Cardiovascular Medicine)

Exam-style valvular, pericardial, and congenital heart diseases viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 26-year-old woman at 18 weeks of gestation presents with worsening exertional dyspnoea, orthopnoea, and sudden-onset rapid palpitations. Physical examination reveals a tapping apex beat, a loud first heart sound, an opening snap, and a mid-diastolic rumbling murmur with presystolic accentuation at the apex. An electrocardiogram confirms atrial fibrillation with rapid ventricular response. Outline your immediate hemodynamic stabilization, diagnostic evaluation using transthoracic echocardiography, indications and safety profile of anticoagulation during pregnancy, and criteria for percutaneou
• SCENARIO 2: A 34-year-old man with a 4-week history of evening pyrexia, weight loss, and night sweats presents with severe dyspnoea, lightheadedness, and cold clammy extremities. Examination reveals blood pressure of 82/54 mmHg, heart rate of 124 beats per minute, elevated jugular venous pressure without a visible y-descent, distant heart sounds, and a systolic blood pressure drop of 18 mmHg during quiet inspiration. Describe your immediate bedside diagnostic approach, key echocardiographic features, emergency procedure preparation, and specific West African protocol for definitive medical therapy.
• SCENARIO 3: A 42-year-old male with a known history of bicuspid aortic valve presents with high-grade swinging fever, progressive malaise, new splinter haemorrhages under the fingernails, and a newly detected early diastolic murmur along the left sternal border. Review the Modified Duke Criteria for the definitive diagnosis of infective endocarditis, blood culture sampling protocols prior to empirical therapy, empiric antimicrobial regimens, and three absolute indications for urgent surgical valve replacement.
• SCENARIO 4: A 48-year-old man presents with persistent abdominal distension, ankle swelling, and profound fatigue. Physical examination reveals marked ascites, tender hepatomegaly, a prominent jugular venous pulsation that paradoxically rises on inspiration (Kussmaul sign), and an early diastolic sound heard along the lower left sternal border (pericardial knock). Differentiate constrictive pericarditis from restrictive cardiomyopathy based on clinical signs, hemodynamic parameters, and imaging findings, and outline the medical and surgical management.
• SCENARIO 5: A 31-year-old woman with an unrepaired large ventricular septal defect presents with central cyanosis, digital clubbing, exertional dyspnoea, and recurrent hemoptysis. A resting room-air pulse oximetry shows SpO₂ of 78%, and blood counts demonstrate a haemoglobin of 21.2 g/dL with a haematocrit of 64%. Discuss the pathophysiology of Eisenmenger syndrome, safe management of secondary erythrocytosis, contraindications to surgical defect closure, and counseling regarding pregnancy risks.