Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) — Viva

Opening (30 s)

"Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) — give a one-line definition and the single most important immediate risk."

Model: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is myocardial ischaemia at rest or on minimal exertion caused by a partially or intermittently occlusive intra-coronary thrombus over a disrupted atherosclerotic plaque, but without the ST elevation that mandates immediate reperfusion. It comprises NSTEMI (myocardial necrosis demonstrated by a rise and/or fall of high-sensitivity cardiac troponin

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: Ischaemic chest pain at rest with dynamic ST depression over 0.5 mm or deep T-wave inversion in multiple leads = NSTE-ACS; serial high-sensitivity troponin to separate NSTEMI from unstable angina

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.)