Mimics of Myocardial Infarction

Updated terminology (ESC 2025)

We use Inflammatory Myopericardial Syndromes (IMPS) in line with contemporary ESC guidance (see European Heart Journal advance article: 10.1093/eurheartj/ehaf192 ).

Definition

Group E includes people who arrive with chest pain, ECG changes and a raised troponin that suggest a heart attack, but are later found to have a mimicking condition. These conditions can look and feel like a heart attack but are not due to a blocked heart artery.

Common mimics

• Inflammatory Myopericardial Syndromes (IMPS) — spectrum from pericarditis → myopericarditis → myocarditis.
• Takotsubo syndrome — stress cardiomyopathy with temporary heart muscle stunning.
• Pulmonary embolism — blood clot in the lungs causing right heart strain and troponin rise.
• Other systemic causes — sepsis, severe hypertension or hypotension, arrhythmias, renal failure, anaemia, and non-cardiac chest pain.

Investigations

• Cardiac MRI (CMR): crucial to distinguish infarction from inflammation or stress cardiomyopathy (oedema patterns; non-ischaemic LGE).
• Laboratory tests: inflammatory markers (CRP/ESR), infection screen, renal profile; autoimmune testing where appropriate.
• Coronary angiography: often performed initially to rule out obstructive coronary artery disease.
• Echocardiography: assesses heart function, pericardial effusion, right heart strain (e.g., in PE).
• CT pulmonary angiography: for suspected pulmonary embolism.

The exact tests depend on your symptoms and the suspected diagnosis.

Management

Care is tailored to the specific condition:

• IMPS: anti-inflammatories and colchicine in pericarditis-predominant cases; activity restriction if myocarditis; heart failure therapy when needed.
• Takotsubo: supportive therapy, manage complications, short-term heart failure medications; psychological support.
• Pulmonary embolism: anticoagulation; investigate provoking factors; specialist care for high-risk cases.
• Other systemic causes: treat the underlying trigger (infection, blood pressure, arrhythmia, anaemia, renal failure).

Prognosis

Outlook depends on the underlying diagnosis. Many conditions (e.g., Takotsubo, pericarditis) improve over weeks to months. Others may require longer follow-up (e.g., recurrent pericarditis, chronic thromboembolic complications after PE).

Knowledge gaps

• Faster pathways to differentiate infarction from mimics in emergency settings.
• Predictors of relapse (IMPS) and recurrence (Takotsubo, PE).
• Best long-term strategies for exercise, rehabilitation, and psychological support.
• Biomarkers and imaging markers to reduce unnecessary invasive procedures.

Research & Support

Learn about ongoing studies in our research section and connect with others in our community forum. For clinical guidance, see the ESC resource above.