Angina or pericarditis

[Pat__0__0]

  Could you please inform me of the symptoms of angina and/or a virus around the heart?  I am a 36 year old female who has pain on an almost daily basis in the left breast area as well as under the left breast, in the left rib cage,left shoulder and arm and sometimes the upper back. The pain eventually subsides and is sometimes an ache or a jabbing pin ***** sensation.  On two occasions I had the pain in the mid chest area.
  I had an echocardiogram done last year due to sudden onset of PVCs.(I was on 60mg of corgard for what had been diagnosed as sinus tachycardia at the time of the echocardiogram and wonder if this makes a difference.) I was told the echocardiogram showed normal results and the PVCs were considered benign.  I was not experiencing the left sided pain at the time of the echocardiogram and this is a relatively new experience which has occurred in the last several months. I have been told that I am "too young" to have structural heart damage or angina and therefore the pain I experience has been largely ignored and left unexplained by two cardiologists I've seen who seem reluctant to perform even a stress test.
  I am wondering if this pain is something to be concerned about and where it might be coming from if it occurs on most occassions on the left side of the heart area.  Is it the norm for indigestion to occur solely on the left side of the heart, shoulder, rib cage and left arm.  I am also wondering whether a normal echocardiogram a year prior can now rule out heart disease in someone my age and why a stress test was not recommended or whether it should be.  Thank you for your time.
  Pat      

[CCF CARDIO MD APS]

_
Dear Pat,
Typical angina is a pressure like pain in the middle of the chest that is brought on by exertion (exercise) and is relieved with rest.  Some patients experience their anginal pain in the shoulder, arms, and, or stomach.  It is highly varible and so it is helpful to have an ecg done while you have the pain.  
For the person who complains (as you do) of more non-specific chest pain, as long as you have no significant risk factors for coronary artery disease (CAD) and a full history and physical exam reveal no concerns regarding CAD, then really there is no indication for a stress test.  This does not mean however that there is nothing wrong, you may have musculoskeletal pain or reflux disease (stomach acid refluxing in to the espohagus from the stomach) and these should be addressed by the physician or by referral to the appropriate physician.
Any test done a year ago, a month ago for that matter, should never be regarded as assurance that all is well when new symptoms develop.  A normal echo last year might make it  unlikely that your heart is abnormal today, regardless you need to report any new symptoms to your physician.
No one is "too young" for heart disease, however as stated before it is the overall picture (history and physical) that determines the risk, not the age or sex of the patient.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.