Valve replacement

• See viva notes on valve replacements
• Midline sternotomy
• Abnormal S1 = mitral
• Abnormal S2 = aortic

Heart failure

• Tachypnoea/tachycardia
• Cool peripheries
• Raised JVP
• Displaced apex
• S3 (ventricular gallop)
• Bi-basal fine crepitations
• Peripheral oedema

Atrial septal defect

• Soft ejection systolic flow murmur (pulmonary area)
• Fixed, widely split S2
• RV heave

Ventricular septal defect

• Pansystolic murmur (loudest at left lower sternal edge)
• Associated thrill
• RV heave/loud P2

Cor pulmonale

• Plethoric facial appearance
• Central cyanosis
• Raised JVP (large ‘a’ waves)
• Giant V waves + pansystolic murmur (if secondary TR)
• Right ventricular heave
• Palpable/loud S2
• Pedal oedema

Hypertrophic obstructive cardiomyopathy

• Pacemaker/implantable cardioverter defibrillator
• Jerky pulse/pulsus bisferiens
• Double apex beat
• Ejection systolic murmur (left lower sternal edge)
• S4

Tetralogy of Fallot repair

• Sternotomy scar (from repair)
• Lateral thoracotomy scar (if had Blalock-Taussig shunt)
• Left pulse weaker (if had Blalock-Taussig shunt)
• Clubbing
• Loud pulmonary stenosis

Coarctation of aorta

Pre-repair

• Radio-femoral delay
• Weak left radial pulse (if stenosis proximal to left subclavian artery)
• Systolic vascular murmur over region of stenosis (most commonly left interscapular or left infraclavicular)
• Severe hypertension

Post-repair

• Left lateral thoracotomy scar

Characteristics of the JVP pulsation that help differentiate it from the carotid pulsation  

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Now try some Viva questions

Some examination OSCE stations

1. Mitral regurgitation
2. Valve replacement
3. Atrial fibrillation
4. Aortic stenosis
5. Lots more here!