Angina Questions

  I have a couple of questions about angina I hope can be answered.  My
  doctor doesn't believe the symptoms described below are angina pains.
  I'm not sure so I am searching for more information.
  I'm 34 year olds.  Father had a MI at 49 and a triple bypass at 59.  My
  cholesterol was nearly 290 but I have gotten it down recently to 197 due
  to dietary changes (Ornish plan).  After going to the hospital one month ago with
  chest and arm pain (plus nausea and a racing heart) I was given a stress
  echo test which came up negative.  My EKG and blood enzymes were normal.
  My doctor believes my pain was due to a spasm in my esophagus.  He said
  the nitro which reduced my chest pain could have relaxed the esophagus.
  He thinks I might have a lot of acid reflux, so he has me taking antacid
  for any chest pains.  I have had some pains below the breast bone
  approximately where the esophagus meets the stomach, which are reduced
  with the antacid.  But I have also had some pains on the left front of
  my chest (usually lasting less than 1 minute so the effect of antacid is
  hard to judge).  My doctor said reflux can back up into the lung.  Both
  of these pains occur when sitting/laying as often (or may be even more
  often) than as when standing.
  Can angina present itself solely as left arm or jaw pain, without any
  chest pain? I have occasionally had both of these, but neither has been
  terribly sharp.
  The jaw pain usually occurs after a meal, and usually last less than 5 minutes.
  Sometimes, though, it occurs soon after I stand up and start walking --
  and then typically goes away within a few minutes (standing still or
  sitting down seems to make it go away quicker).
  The left arm pain occurs mostly when standing or walking, but can be
  reduced or eliminated by raising my arm.  It's mainly in my forearm, but
  occurs occasionally in my elbow.  My doctor says if the arm pain goes
  away by moving it, then it is not angina.
  Any thoughts or insights appreciatted.  My doctor was reasonably
  informative, but I wanted to learn as much as I could.
  Tom

[CCF Cardio MD-SGM]

_-
Dear Tom,
Your doctor is correct in the information he/she has conveyed to your regarding the quality of your chest and epigastric pains.  Although these might be cardiac in nature, it is also quite possible that gastrointestinal disorders (acid reflux, for example) might be causative.  The symptoms you have are somewhat atypical for angina, although it is not uncommon for heart pain to present in an atypical fashion.  It was proper and prudent to perform a functional study of the heart(stress test) to better gauge the likelihood that your pain is cardiac.  A stress echo is an excellent test to answer this question, but it is not perfect or foolproof.  Sensitivity of the study is estimated at approximately 90 percent, meaning that it fails to detect significant coronary artery disease in about ten percent of patients who undergo the test.  As far as tests go,  it doesn't get a whole lot better than this (few tests are perfect), although this is little consolation for the patients with significant disease who go undetected.  
At this point, you need to decide how comfortable you are with your doctor's advice and recommendations.  Clearly,  I would be remiss in trying to diagnose your symptoms via an internet forum, and a real-live doctor is vastly superior in making subtle judgment calls like this.  However, it would be reasonable to pursue a second opinion if you so desire.  In the most aggressive scenario, a repeat functional study (stress thallium, or PET scan, for example) or even a cardiac catheterization could be performed to more certainly rule out a cardiac cause for your symptoms.  
Information in the Heart Forum is for general purposes.  Specific diagnoses and therapies can  only be provided by your physician.