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Opening (30 s)
"Chronic Coronary Syndrome — give a one-line definition and the single most important immediate risk."
Model: 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 a fixed or dynamic epicardial stenosis, microvascular dysfunction, or vasospasm; severity is graded I to IV on the Canadian Cardiovascular Society scale. The single most important immediate risk is the crossing into an acute coronary syndrome — rest angina, prolonged pain or a crescendo pattern is unstable until proven otherwise.[1][2]
Station 1 — Pathophysiology (2 min)
Explain the mechanism chain from cause to clinical features and one major complication.
Station 2 — Clinical diagnosis (2 min)
Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.
Red flag cue: Sudden accelerating or crescendo angina pattern over days to weeks — signals plaque instability and imminent acute coronary syndrome; needs urgent cardiology review, anti-ischaemic intensification, and consideration of inpatient angiography.[1]
Station 3 — Investigations (2 min)
First-line tests, definitive tests, and any named score with exact components.
Station 4 — Emergency management (3 min)
ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.
Station 5 — Definitive / long-term care (2 min)
Stepwise definitive therapy, monitoring, complications of treatment, follow-up.
Station 6 — Special populations (2 min)
Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.
Station 7 — Evidence & pitfalls (2 min)
Landmark trial or guideline name if standard; three classic exam traps.
Station 8 — Rapid-fire pearls (1 min)
Five high-yield facts a candidate must not forget under time pressure.
Examiner pass criteria
- Speaks in mechanisms and numbers, not vague lists
- Gives at least one exact dose or threshold
- Names escalation criteria
- Avoids dangerous delays (imaging when unstable, etc.)
References2ShowHide
- [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
- [2]Campeau L. Letter: Grading of angina pectoris. Circulation, 1976.PMID 947585