Chest Pain / dizziness

[Tomy__0]

  Hi. I am a 26 year old male 275lb weightlifter with a history of high cholesterol.  Recently I had an episode of severe lightheadedness.  It only lasted a minute but I freaked out and went to an ER.  An EKG was normal so the doc suggested a follow up.
  The follow up with the internal medicine doctor showed normal EKG, blood pressure and heart rate, but extremely elevated cholesterol(308).  Shortly  after the incident, I developed dizziness and chest pain.  I saw the doctor again and she referred me to a cardiologist.  A stress test and heart ultrasound revealed a healthy heart.  He counseled me about my diet and said CAD was unlikely at this point.  The cardiologist deemed the episode to be a vaso-vagal reaction and not to worry about it.
  However,  I began having anxiety attacks and chest pains.  The internal medicine doctored prescribed Xanax and Flexoril.  She said the symptoms were not typical of Angina and the cardiologist had ruled out heart problems.  The dizziness, which worsened considerable with exercise has eventually cleared up even after heavy cardio training and intensive weight training.
  Massage therapy has seemed to help my chest pain.  However,  I still have bouts of chest pain and anxiety, usually in the late afternoon which still have me very anxious.  The pain feels like something is pressing on my sternum.  Occasionally the pain will radiate to the left side and to the back.  After a massage,  the pain is alleviated.  Exercise does not increase the pain at all.  In fact,  there is usually no pain at all when I am exercising.  Anti-inflammatories do not seem to do much good during an attack.  The Xanax seems to work the best.  
  Sorry for the long winded note.  My questions:  what do you think the cause of the dizziness was/is?  Should I be worried about the chest pain?  
  Thank you in advance.
  Tommy

[Cleveland Clinic, MD]

Dear  Tommy,
There are many causes of chest pain and dizziness.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out the work-up can proceed at a more leisurely pace.  
Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
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.