MI Pretty Peaceful APE: Differentials for Sinister causes of chest pain

In Featured by Revathi NairLeave a Comment

About 1 in 10 cases seen in the Emergency department involve chest pain. While some of these causes are benign or subacute, there are six emergent and sinister causes of chest pain that one would want to consider first before exploring other diagnoses.

The mnemonic “MI Pretty Peaceful APE” can be used to quickly recall these sinister causes in order from most to least frequent presentations. Given below are those conditions, their prevalence, and some clinical characteristics that can be used to differentiate them:

This post was copyedited by @jamievanderende.


1.        Olszynski P. Approach to Chest Pain. University of Saskatchewan; 2021.

2.        Marx J, Hockberger R, Walls R. Rosen’s Emergency Medicine. 9th ed. Elsevier; 2013.

3.        Stone CK, Humphries RL. Current Diagnosis and Treatment: Emergency Medicine. Vol. 7, Academic Emergency Medicine. 2011.

Reviewing With the Staff

When assessing a patient with chest pain, it is important to consider sinister causes while also keeping in mind the prevalence of these conditions. In doing so, assessments are initially focused on common conditions, and then adapted to explore less common conditions as directed by the clinical assessment. This leads to thorough but efficient assessments of time-sensitive and potentially life-threatening conditions.

Paul Olszynski
Dr. Olszynski is a physician and associate professor of emergency medicine at the University of Saskatchewan. He also serves as the Director of Emergency Ultrasound and is responsible for spearheading Point of Care Ultrasound education at the University of Saskatchewan.

Revathi Nair

Rey is the Director of Multimedia at CanadiEM and a third year medical student at University of Saskatchewan. Her current academic interests include Medical Education and Ultrasound. In her spare time, she likes to spend time with family and friends and pretend she is a contestant on the MasterChef (with little success).

Latest posts by Revathi Nair (see all)