Hyperkalaemia can mimic STEMI, but true coronary occlusion and hyperkalaemia may coexist. The challenge is to recognise the ECG abnormalities, confirm potassium rapidly, treat life-threatening hyperkalaemia and avoid delaying reperfusion.

The key principle is parallel management: investigate and treat hyperkalaemia while activating the primary PCI pathway when acute coronary occlusion remains a credible diagnosis.

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