Many disorders can mimic an acute coronary syndrome in both the symptomatic presentation and the ECG findings. Remember the true definition of an acute coronary syndrome implies an unstable atherosclerotic coronary plaque and thrombosis. Other disorders that can cause anginal symptoms and ischemic ST elevation on the ECG, but are not from atherosclerotic plaque rupture or erosion include:

1.Coronary spasm
2. Aortic dissection
3. Vasculitis
4. Takotsubo cardiomyopathy (stress-induced cardiomyopathy)
5. Radiation therapy
6. Coronary embolus
7. Cocaine use
8. Trauma or cardiac contusion
9. Congenital coronary anomalies

Conditions that cause ECG findings similar to acute coronary syndromes include:

1. Left bundle branch block (usually not from acute myocardial infarction, but at times can be - see Sgarbossa criteria, Chapman’s sign and Cabrera’s sign)
2. Left ventricular hypertrophy with repolarization abnormalities
3. Pericarditis
4. Early repolarization