MI: Step 1 review notes and self-test
Notes for the MI rapid review: the clue that separates each of its 6 confusion pairs, with timestamps and a self-test.
October 21, 2026
This video covers how to separate common chest pain and myocardial infarction patterns using their key clues. Watch the video, then use these notes to test yourself.
Stable angina vs Acute coronary syndrome
Stable angina causes predictable exertional chest pressure relieved by rest or nitroglycerin, while new, worsening, or rest pain is acute coronary syndrome until ECG and biomarkers classify it. A normal first troponin and normal ECG do not make new-onset, rest, or crescendo pain stable, so use serial troponins and ECGs every 3 to 6 hours.
Stable angina vs Acute coronary syndrome Stable is predictable demand ischemia; new, worse, or rest pain is ACS until biomarkers and ECG classify it. Open the comparison and video →Stable and unstable angina vs Prinzmetal angina
Stable angina follows a predictable exertional pattern, unstable angina causes new, worsening, or rest pain without troponin elevation, and Prinzmetal angina causes episodic rest pain with transient ST elevation from coronary vasospasm. Rest pain can occur with unstable angina or Prinzmetal angina, so transient ST elevation that resolves with vasodilators is the clue for vasospasm.
Stable and unstable angina vs Prinzmetal angina Stable/unstable angina is plaque-demand or ACS pattern; Prinzmetal is vasospasm with transient ST elevation. Open the comparison and video →NSTEMI vs STEMI
NSTEMI causes troponin elevation without ST elevation criteria, while STEMI produces regional ST elevation in contiguous leads or an equivalent acute occlusion pattern. Do not miss posterior MI, Sgarbossa criteria with new left bundle branch block, de Winter T waves, or Wellens syndrome because STEMI physiology may appear without classic ST elevation.
NSTEMI vs STEMI NSTEMI is troponin positive without ST elevation criteria; STEMI is territorial ST elevation or equivalent occlusion pattern. Open the comparison and video →Type I myocardial infarction vs Type II myocardial infarction
Type I myocardial infarction results from plaque rupture or erosion with coronary thrombosis, while Type II results from an oxygen supply-demand mismatch without acute plaque thrombosis. A troponin rise shows injury, but its magnitude does not define the type. Use the clinical scenario, ECG, and angiography when indicated to identify the mechanism.
Type I myocardial infarction vs Type II myocardial infarction Type I MI: atherothrombotic plaque rupture with coronary thrombus; type II MI: oxygen supply-demand mismatch without plaque rupture. Open the comparison and video →Acute pericarditis vs Myocardial infarction on ECG
Acute pericarditis produces diffuse concave ST elevation with PR depression, while myocardial infarction produces regional ST elevation in a coronary territory with reciprocal changes. ST elevation alone does not decide because you must determine whether the pattern crosses multiple coronary territories or maps to one artery. Pericarditis has no Q waves or reciprocal depression, while myocardial infarction can have reciprocal ST depression and evolving Q waves.
Acute pericarditis vs Myocardial infarction on ECG Pericarditis is diffuse ST elevation plus PR depression; MI is regional ST elevation with reciprocal changes. Open the comparison and video →Aortic dissection vs Myocardial infarction / pulmonary embolism
Aortic dissection causes abrupt tearing chest pain radiating to the back with aortic or branch-vessel clues, while myocardial infarction causes ischemic pressure with an ECG and troponin pattern and pulmonary embolism causes pleuritic pain with hypoxemic thromboembolism clues. Troponin can rise in aortic dissection, so do not overlook pulse deficits or neurologic symptoms before anticoagulation.
Aortic dissection vs Myocardial infarction / pulmonary embolism Dissection is chest pain plus aortic/branch-vessel clues; MI is coronary ischemia; PE is pleuritic hypoxemic thromboembolism. Open the comparison and video →Quick self-test
Name the diagnosis from the clue, then tap to check.
Troponin elevation with ischemic symptoms but no ST elevation criteria; ECG may show ST depression or T-wave inversion.
NSTEMI · NSTEMI vs STEMI
Acute atherothrombotic plaque rupture or erosion causing coronary thrombosis.
Type I myocardial infarction · Type I myocardial infarction vs Type II myocardial infarction
Pleuritic positional chest pain with diffuse concave ST elevation and PR depression.
Acute pericarditis · Acute pericarditis vs Myocardial infarction on ECG
New, worsening, or rest chest pain requiring ACS framing: unstable angina, NSTEMI, or STEMI.
Acute coronary syndrome · Stable angina vs Acute coronary syndrome
Episodic rest pain from coronary vasospasm with transient ST elevation, often relieved by nitrates or calcium channel blockers.
Prinzmetal angina · Stable and unstable angina vs Prinzmetal angina
MI is ischemic pressure with ECG/troponin pattern; PE is pleuritic pain with dyspnea, tachycardia, hypoxemia, and thromboembolic risk.
Myocardial infarction / pulmonary embolism · Aortic dissection vs Myocardial infarction / pulmonary embolism
Predictable exertional chest pressure relieved by rest or nitroglycerin.
Stable angina · Stable angina vs Acute coronary syndrome
Regional ST elevation in contiguous leads or equivalent pattern suggesting acute coronary occlusion requiring urgent reperfusion pathway.
STEMI · NSTEMI vs STEMI
Oxygen supply-demand mismatch from sepsis, anemia, hypoxia, tachyarrhythmia, hypotension, or severe hypertension without acute plaque thrombosis.
Type II myocardial infarction · Type I myocardial infarction vs Type II myocardial infarction
Regional ST elevation in a coronary territory with reciprocal ST depression, evolving Q waves, and ischemic symptoms.
Myocardial infarction on ECG · Acute pericarditis vs Myocardial infarction on ECG
Keep going
Every pair in this review has a free page in the library with a side-by-side comparison and a practice question. Work through the ones you missed in the self-test first.