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An OSCE case involving a 40-year-old man presenting with one hour of chest pain. The RMO misattributes ECG findings to hyperkalaemia due to gym supplements after discussing with the Cardiology RMO. Candidates must recognise the ECG as showing left main coronary artery (LMCA) stenosis—a STEMI equivalent—explain the management of acute coronary syndrome, address knowledge gaps in the RMOs, and discuss appropriate escalation and supervision pathways.