MBBS OSCE · Cardiology
OSCE — Chronic Coronary Syndrome
Eight-minute OSCE station on Chronic Coronary Syndrome: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Chronic Coronary Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Chronic coronary syndrome (CCS) is the modern umbrella term replacing "stable angina" for the long-term presentations of coronary artery disease. Defined by the 2019 ESC Guidelines as the spectrum of clinical presentations driven by chronic, often predictable, myocardial ischaemia typically precipitated by exertion or emotional stress and relieved by rest or sublingual nitrates. Anatomically it is the consequence of fixed or dynamic epicardial coronary stenosis (atherosclerotic plaque with intact fibrous cap), microvascular dysfunction, or vasospasm. The classic presentation is substernal chest discomfort provoked by exertion and resolving within minutes of rest or nitroglycerin.[1]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Recognises crescendo angina over days to weeks as imminent ACS |
| Safety | Recognises rest angina over 20 minutes, dynamic ECG change or new LV dysfunction as NSTE-ACS |
| Safety | Recognises angina with new heart-failure signs (orthopnoea, S3, crackles) as high risk |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1]
References1ShowHide
- [1]Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 2020.PMID 31504439