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PE22.1-11 | Cardiovascular System — Assignment
CLINICAL SCENARIO
You will document a real or simulated clinical encounter with a child presenting with a cardiac murmur or known congenital/acquired heart disease. By constructing a structured case write-up you will integrate cardiovascular examination findings, haemodynamic reasoning, ECG and CXR interpretation, and evidence-based management planning — mirroring the cognitive workflow expected of a final-year MBBS student in a paediatric cardiology setting.
Instructions
Select a clinical case (from bedside, outpatient, or a provided simulated case if bedside access is unavailable). The child may have a congenital heart disease (acyanotic or cyanotic), cardiac failure, acute rheumatic fever, infective endocarditis, or paediatric hypertension. Write up the case following the scaffolding sections below. Use Ghai's Essential Pediatrics and IAP guidelines as your primary references. All drug doses must be cited in mg/kg. Avoid disclosing patient-identifying information; use initials and replace dates with age/timeline.
Length: 1200–1600 words (excluding investigation reports and references)
What to Submit
1. Case Summary (100–150 words)
Guidance: Briefly present the child: age, sex, presenting complaint, key examination findings, and working diagnosis. State which cardiovascular competency domain this case addresses (acyanotic CHD / cyanotic CHD / cardiac failure / ARF / IE / hypertension).
2. History and Examination
Guidance: Document: age at onset, feeding difficulties, growth parameters (weight, height, MUAC), cyanosis, squatting posture, palpitations, oedema. Cardiovascular exam: precordial bulge, apex beat, thrills, auscultation (murmur grade, quality, timing, location, radiation), S2 character (split, loud P2), added sounds. Also document respiratory rate, pulse rate and character, BP (with age-sex-height normative context for paediatric HTN).
3. Interpretation of Investigations
Guidance: Attach or describe the CXR findings: comment on cardiothoracic ratio (normal >2 yr is ≤0.5), pulmonary vascular markings (plethora / oligaemia / normal), cardiac silhouette shape. ECG: rate, axis, RV/LV dominance pattern, PR interval, QTc. Echo (if available): defect anatomy, shunt direction, ventricular function, PA pressures.
4. Haemodynamic Reasoning
Guidance: Explain the underlying haemodynamic disturbance in your case. For L-to-R shunts: describe increased Qp:Qs and consequences; for cyanotic CHD: explain R-to-L shunt and ductal dependence; for ARF/IE: explain valve dysfunction; for paediatric HTN: explain target-organ risk. Discuss how the haemodynamics explain each clinical sign found.
5. Management Plan
Guidance: Provide a comprehensive, evidence-based management plan. All drug doses MUST be weight-based (mg/kg). For cardiac failure: digoxin + furosemide ± captopril; for TOF tet-spell: knee-chest + morphine + propranolol; for ARF: benzathine penicillin secondary prophylaxis duration, aspirin for carditis (NOT chorea — use haloperidol/valproate); for IE: 4–6 weeks IV antibiotics per organism; for paediatric HTN: lifestyle first, then weight-based pharmacotherapy. State timing and criteria for surgical/catheter referral.
6. Empathic Communication Note
Guidance: Write a brief reflection (100–150 words) on how you communicated the diagnosis and management plan to the child's family. What language did you use? How did you address parental anxiety about surgery or long-term medication? Reference PE22.11 — demonstrating empathy in every encounter.
Grading Rubric — Cardiovascular Case Write-Up Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Accuracy of cardiovascular examination documentation and interpretation | 20 pts | Systematically documents all CVS examination components (precordial bulge, apex, thrills, murmur grade/timing/location/radiation, S2 character, JVP); findings correctly interpreted and linked to diagnosis. |
| ECG and CXR interpretation | 15 pts | CTR correctly calculated and reported; pulmonary vascular marking pattern correctly labelled (plethora/oligaemia/normal) and explained; ECG axis and dominance pattern correctly interpreted for age with paediatric normative context. |
| Haemodynamic reasoning | 20 pts | Correctly explains shunt direction, Qp:Qs, and/or valve dysfunction; logically maps each haemodynamic change to a specific clinical sign; Eisenmenger/ductal-dependence concepts used correctly if applicable. |
| Management plan — evidence-based and weight-based dosing | 25 pts | All drugs prescribed at correct mg/kg doses with appropriate indications; secondary prophylaxis duration correct for ARF; tet-spell steps in correct order; aspirin NOT prescribed for chorea; surgical/catheter referral criteria clearly stated. |
| Empathic communication reflection | 10 pts | Reflection is genuine and specific; describes actual language used with the family; addresses parental anxiety about prognosis/surgery; cites a concrete moment of empathic communication. |
| Structure, references, and academic writing quality | 10 pts | All sections present; within word guidance; at least 3 references from Ghai/Nelson/IAP guidelines; no patient identifying information; professional academic writing. |
PEER REVIEW
Review your peer's case write-up using the rubric criteria. For each criterion, identify one specific strength and one specific suggestion for improvement. Pay particular attention to: (1) Are all drug doses written in mg/kg? (2) Is aspirin correctly NOT prescribed for Sydenham chorea? (3) Is the CTR calculated and the paediatric ECG interpreted with age-appropriate norms? Provide written comments of at least 3 sentences per criterion. Complete peer review within 5 days of submission.