chest pain for 3 years, cardio workup, please direct me

i'm a 34 yr old m w/no family hist of heart disease, diabetes...everyone is healthy.  about 10 yrs ago, i started having breathing problems. i would get very bloated in my chest and would feel like i couldn't breath. my gall bladder was taken out. it didn't help . 3 yrs ago i started having left side chest pain, an achy pain sometimes stinging with occasional left arm pain. i went to my gp who done a stess, ekg and echo-all ok. i started a steroid pack and anti-inflam, with no help. i visited a gastro doc who done a endoscopy and found nothing that should be causing my problems. he did put me on meds for p.h. plyora and protonix. which helped with heartburn. he sent me to a neuro who done a bonescan and a test with needles in my back, everything ok.  i went to a cardiologist, had a nuclear stress, echo and a 64slice ct .  everything ok except for a "clinically insignificant myocardial bridge". my calcium score and splash % were perfect. i then went to a pulmonary doc who done a chest ct and asthma test, i've had a 6mth and 12mth follow-up ct scan to insure a very minor lung scar from pneumonia when i was a child, other than that, normal.i went back to my gp and had a neck and chest mri-ok..
the pain is not a bend over pain, just a achy pain or stinging sometimes that runs down my arm. my back is hurting consistently now about mid shoulder blade near my spine. the pain hasn't gotten worse over the years, it's just causing some pretty bad anxiety.  i know now that all docs contribute what they cant find to anxiety, but i know the anxiety, it causes me lightheaded, fear, flushing and hotflashes, palps but it all starts after the chest pain.  i can't say if its positional, nothing specific causes it.  it's aggravating, it hurts when i excercise and gets me into an anxiety attack. by the way i was hurting during the stress test. please direct me on this, i don't know who to see next.

[J T Junig, MD PhD]

I'm running through the organ systems that could cause such pain, and I think you have covered about everything!  Pain in the left chest and back, achy or 'stinging', running down the arm on the left, associated at times with anxiety...  you have checked out the cardiac system to make sure you are not having a heart attack of aneurysm;  you saw a neurologist to rule out pain from spinal stenosis or nerve root compression (I presume the test with needles was an EMG); GE reflux or hiatal hernia was treated; pain from the gallbladder-- unlikely as a source-- but was ruled out by taking out the gallbladder (of all things!); pain from the lungs was considered and nothing found by a pulmonologist...

I don't have much to add.  Were I in your place, I would do as you did-- rule out the dangerous things by seeing appropriate specialists.  The only thing missing from your work-up is the kindly, reassuring GP to look at all the tests and tell you 'not to worry--  everything will be OK'.  

Were I your psychiatrist, I would want to know more about the period of time when you couldn't breathe-- what that was all about.  Was that all related to anxiety?  If so, what were you anxious about?  Your symptoms would be classic, for example, for a person who lost his father from a heart attack during childhood;  the symptoms could be seen as coming from unconscious fears of death, particularly if they started right after the birth of your own children.  I'm not saying that I think your symptoms are psychological-- only that there are people who will present with such symptoms and findings.

Since the pain is often tied to the anxiety, I would certainly work toward reducing the anxiety, whether through medication, psychotherapy, low-grade exercise...  and even if the pain is not directly related, I would expect it to improve given what you have described.

Good luck,

JJ