A working method for cardiology viva questions
Cardiology viva questions test more than whether you can name a diagnosis. A strong spoken answer shows that you can recognise immediate danger, explain your reasoning, choose a safe next step and communicate a plan clearly. Practise saying those steps aloud, rather than relying on notes that only make sense when you read them.
The cases below cover common clinical themes, not the syllabus or format of a particular examination. Requirements differ between countries and examining bodies. Check the relevant official guidance for local protocols, drug choices and any exam-specific expectations.
For each case, use the same sequence:
- State your priorities. Say whether the patient is stable and what you would do immediately.
- Give your working diagnosis and alternatives. Link the findings to your reasoning.
- Describe investigations and treatment in order. Make clear what must happen now and what can follow.
- Close the loop. Mention monitoring, reassessment, communication and disposition.
If you need a moment to think, say what you are assessing: “I would first check whether the patient is haemodynamically unstable.” That is more useful than going silent or listing every possible diagnosis without prioritising.
A practice examiner strip in MySummaries can keep those speaking priorities in view. Its emphases are prompts for practice, not a universal or official cardiology examination rubric.
Choose a case and answer aloud
A viva case should give you a clear opening task, then let you practise making decisions as new information appears. Start by speaking for two or three minutes without reading a model answer. Afterward, review where you delayed an urgent action, skipped a reason or used a vague phrase such as “I would manage appropriately”. Replace vague language with a specific next step.
These four stations are useful starting points: one acute coronary presentation, one arrhythmia, one acute heart-failure presentation and one stable outpatient problem. The attempt count helps distinguish a case you have rehearsed from one you have not yet sat.
MySummaries can organise these practice stations from a cardiology revision board and retain your attempt history.
Station 1: Inferior STEMI with hypotension
The key in this case is not to stop at “inferior STEMI”. The low blood pressure and slow pulse change what you should consider and what treatment could be harmful. Start with immediate assessment and escalation; do not bury the reperfusion plan beneath a long differential diagnosis.
A practice marking panel in MySummaries breaks the spoken answer into safety, interpretation, treatment and communication. The score is platform feedback for this attempt, not a prediction of an examination result.
Examiner
A 62-year-old has crushing chest pain, sweating and nausea. The ECG shows ST elevation in II, III and aVF with reciprocal depression in I and aVL. His blood pressure is 92/60 mmHg and pulse 48/min. Talk me through your immediate assessment and management.
You prioritised monitoring, repeat observations and urgent senior/catheter-laboratory involvement.
ImproveSay explicitly that you would assess airway, breathing and circulation and obtain IV access while escalating.
You identified an inferior STEMI and recognised that bradycardia and hypotension raise concern for right-ventricular involvement.
ImproveState that you would obtain right-sided leads, particularly V4R, and assess for heart block.
You named aspirin and urgent primary PCI, but did not link the hypotension to avoiding nitrates.
ImproveState that nitrates may worsen hypotension and should be avoided here; use local ACS protocol for antithrombotic treatment.
You planned continuous monitoring but gave limited detail on reassessment and explaining the urgent plan.
ImproveMention frequent observations, response to treatment and a clear handover to the receiving cardiac team.
A strong answerI would assess airway, breathing and circulation, attach continuous ECG and oxygen-saturation monitoring, obtain IV access and call for urgent senior and interventional cardiology support. The ECG is an inferior STEMI; with hypotension and bradycardia I would consider right-ventricular infarction and conduction block, obtain right-sided leads including V4R, and reassess haemodynamics. I would give an aspirin loading dose according to local ACS protocol if there is no contraindication, and arrange immediate reperfusion by the local primary PCI pathway. I would avoid nitrates because he is hypotensive, and would not give oxygen routinely if he is not hypoxaemic. I would monitor closely, treat deterioration promptly and hand over the ECG, observations and treatments already given.
That is a MySummaries station, filled with cardiology material. Yours is written from your own notes. Start free
What makes that answer work
It puts assessment and escalation first, then interprets the ECG in the context of the observations. The finding of inferior ST elevation makes an inferior infarct likely; hypotension and bradycardia prompt you to assess for right-ventricular involvement and conduction disturbance. The answer also explains a treatment decision: nitrates can further lower blood pressure, so they are unsafe in this presentation.
Avoid giving a rigid drug list without checking contraindications or local protocols. In an international viva, name the treatment principle and say that antithrombotic choices and doses should follow the local acute coronary syndrome pathway. Reperfusion should remain prominent in your answer.
Station 2: Atrial fibrillation with a rapid rate
This case tests whether you separate immediate stability from longer-term stroke prevention. Do not jump straight to a rate-control drug: first decide whether the patient is unstable, confirm the rhythm and look for a trigger. Then give a plan for rate or rhythm management and assess thromboembolic risk.
MySummaries can mark a spoken attempt and identify where a candidate has named a treatment without explaining the decision behind it.
Examiner
A 74-year-old presents with palpitations. The ECG shows an irregular narrow-complex rhythm at 150/min. Blood pressure is 132/78 mmHg, and there is no chest pain or syncope. How would you assess and manage this patient?
You checked observations and interpreted the irregular narrow-complex rhythm as likely atrial fibrillation.
ImproveState what instability would look like and that unstable AF requires urgent synchronised cardioversion under local guidance.
You proposed rate control and mentioned infection and thyroid disease as possible triggers.
ImproveName an appropriate rate-control option after checking contraindications, ventricular function and the clinical context.
You recognised the need to assess embolic risk but did not explain that aspirin is not a substitute for indicated anticoagulation.
ImproveUse the stroke-risk tool recommended locally, assess bleeding risk and discuss anticoagulation when indicated.
You planned follow-up but did not explain how you would discuss the risks and choices with the patient.
ImproveExplain the options, check preferences and arrange review of rate, symptoms and anticoagulation.
A strong answerI would first assess haemodynamic stability, including blood pressure, perfusion, chest pain, heart failure and syncope, and review the ECG to confirm atrial fibrillation. If the patient became unstable, I would call for urgent help and arrange synchronised cardioversion according to local protocol. As he is currently stable, I would assess duration of symptoms, medication, comorbidities and reversible causes such as infection, thyroid disease or electrolyte disturbance. I would choose rate or rhythm management based on symptoms, duration, ventricular function and local guidance; for rate control, I would check contraindications before selecting a beta blocker or a rate-limiting calcium-channel blocker. I would assess stroke risk with the locally recommended tool and discuss anticoagulation if indicated; aspirin is not an alternative to anticoagulation for AF-related stroke prevention. I would agree follow-up and explain the plan and warning symptoms.
Make the decision explicit
A useful answer distinguishes an unstable patient, who may need urgent synchronised cardioversion, from this currently stable patient. In a stable patient, management depends on symptoms, duration of AF, comorbidities, ventricular function and the applicable local guideline. Beta blockers and rate-limiting calcium-channel blockers are not interchangeable in every patient; for example, verapamil or diltiazem may be unsuitable in significant systolic heart failure.
For stroke prevention, name the principle rather than assuming one scoring system is used everywhere. Apply the tool and anticoagulation guidance recommended in the patient’s country. Do not imply that aspirin provides equivalent protection. A patient-centred answer mentions discussion of benefits, risks and preferences, not just a prescription.
Station 3: Acute pulmonary oedema
In acute breathlessness, show that you can treat the patient while investigating the cause. State how you will support oxygenation, identify respiratory distress and monitor response. Then look for a precipitant such as acute ischaemia, arrhythmia, infection, uncontrolled blood pressure or a medication problem.
A third MySummaries oral attempt can show whether you remember to reassess after the initial treatment, rather than ending your answer at the first prescription.
Examiner
A 68-year-old with known heart failure is acutely breathless, with oxygen saturation 88% on room air, raised JVP, bilateral crackles and blood pressure 168/96 mmHg. What are your immediate priorities and how would you investigate the cause?
You recognised acute pulmonary oedema and prioritised positioning, monitoring and oxygen for hypoxaemia.
ImproveState that you would assess work of breathing and escalate early if respiratory failure is worsening.
You proposed an IV loop diuretic and considered non-invasive ventilation for persistent severe distress.
ImproveMention that nitrates may be considered in hypertensive pulmonary oedema if there is no contraindication, following local protocol.
You mentioned ischaemia and arrhythmia but did not give a sufficiently broad initial work-up.
ImproveInclude ECG, chest imaging and blood tests, with troponin and natriuretic peptide where appropriate.
You planned admission but did not say how you would judge response or escalate if the patient worsened.
ImproveRepeat observations, oxygenation and clinical examination; escalate for worsening respiratory distress or haemodynamic compromise.
A strong answerI would sit the patient upright, assess airway, breathing and circulation, attach continuous monitoring, obtain IV access and call for senior help because the oxygen saturation is 88% on room air. I would give oxygen for hypoxaemia and reassess saturation and work of breathing; if respiratory distress or hypoxaemia persists, I would consider non-invasive ventilation and escalate according to local practice. The findings suggest acute pulmonary oedema, so I would consider an IV loop diuretic and, given the raised blood pressure, nitrates if appropriate and not contraindicated. I would investigate the precipitant with an ECG, chest imaging and blood tests including renal function, electrolytes and troponin; natriuretic peptide and echocardiography may help as clinically indicated. I would look for ischaemia, arrhythmia, infection, uncontrolled hypertension and medication or fluid-related causes. I would repeat observations and examination, monitor urine output and response, and arrange an appropriate monitored level of care.
Review the missing marks, not just the score
The answer is stronger when it matches treatment to the specific presentation. Here, hypoxaemia makes oxygen appropriate; the raised blood pressure allows consideration of nitrates if there is no contraindication, while the signs of congestion support a loop diuretic. These decisions still need to follow the patient’s circumstances and local protocols.
The investigation plan should be focused rather than exhaustive. ECG and chest imaging help assess the presentation; blood tests can identify renal or electrolyte problems and support assessment for myocardial injury or heart failure. Reassess the patient after treatment. If breathing, oxygenation or circulation deteriorates, escalate rather than continuing a routine ward plan.
A transcript that turns vague speech into a better answer
After a practice station, inspect the words that cost marks. A statement can be clinically sensible but too vague to show that you know what happens next. Replace general phrases with an action, a reason and a condition where relevant.
MySummaries can highlight one weak phrase from an answer and give you a more precise version to practise.
I would assess him, get an ECG and treat the heart failure. I would give oxygen and diuretics and see how he does. I would also look for a cause. If he gets worse, I would get help.
I would also look for a cause.
This signals that you know a precipitant matters, but it does not show what you would look for or how you would investigate it.
Say: I would look for ischaemia, arrhythmia, infection and uncontrolled blood pressure, using an ECG, chest imaging and appropriate blood tests, then reassess the response to treatment.Try this correction aloud until it sounds natural. Do not memorise a script word for word: a new case may change the priorities. Instead, learn the structure and the clinical links—for example, hypoxaemia leads to oxygen and reassessment, while hypotension in an inferior infarct makes nitrates unsafe.
A short examiner-voice debrief can reinforce one specific point from a station. The feedback should be actionable, not a general judgement about whether you sounded confident.
You recognised pulmonary oedema; next, name the precipitant you are checking and how you will reassess the response.
Build a repeatable practice routine
Use a small number of cases repeatedly, changing one detail each time: a stable patient becomes hypotensive, a murmur is accompanied by syncope, or heart failure occurs with a new arrhythmia. That forces you to explain how the change affects your priorities instead of reciting a memorised answer.
After each attempt, write down just three things:
- One decision you made well, and the evidence that supported it.
- One omission, such as failing to mention a contraindication or escalation.
- One sentence to improve, rewritten as a specific action with a reason.
Then sit the case again after reviewing the relevant section of your own notes. If you are uncertain about a dose, threshold or local treatment pathway, check a current authoritative guideline for your country. Do not rely on a practice transcript to settle a local protocol question.
How MySummaries helps
Build a cardiology board from your own notes, then use it to organise oral cases, record spoken attempts and review specific omissions. The examiner-style feedback is practice support; it does not replace your course’s criteria or local clinical guidance. Open MySummaries.