Many disorders can mimic STEMI in both the symptomatic presentation and the ECG findings. Remember STEMI is an acute coronary syndrome which implies an unstable atherosclerotic plaque and thrombosis. Other disorders that can cause anginal type symptoms and ischemic ST elevation on the ECG, but are not from atherosclerotic plaque rupture include: Coronary spasm, aortic dissection, vasculitis, Takotsubo cardiomyopathy (stress-induced cardiomyopathy), radiation therapy, coronary embolus, non-cardiac chest pain with chronic ECG changes (LBBB or LVH), myocarditis, cocaine use, trauma or cardiac contusion, and congenital coronary anomalies.

Conditions than mimic the symptoms of angina but are not related to ischemia either by coronary thrombosis or demand ischemia are musculoskeletal pain, aortic dissection, pulmonary embolism, esophageal spasm, Da Costa’s syndrome, syndrome X, gastroesophageal reflux disease and gallbladder disease.