The second session of the Lifelong Emergency Medicine Exchange and Discussion (LEED) Series was held on April 1, 2026, on the topic “Approach to Acute Coronary Syndromes in Resource-Limited Settings.” The session was delivered by Dr. Prakash Acharya, an interventional cardiologist at Missouri Heart Center. Dr. Acharya received his medical degree from the Institute of Medicine, Tribhuvan University, in 2012 and completed his interventional cardiology training at the University of Kansas Medical Center. He is board certified in internal medicine, cardiovascular disease, echocardiography, nuclear cardiology, and interventional cardiology. His areas of specialization include coronary and peripheral vascular interventions. The session followed the usual LEED format, beginning with an undifferentiated emergency department case and building the clinical approach step by step. The discussion focused on the practical management of acute coronary syndromes in resource-limited settings, including STEMI, STEMI equivalents, NSTEMI, the role of troponins, and decision-making when catheterization laboratory access is limited by time, distance, transport barriers, or local resource constraints. Participants from Nepal were invited to comment on the availability of high-sensitivity troponins and thrombolytics, making the session highly relevant to real-world emergency and critical care practice in Nepal.