Chest pain but not a heart attack"

[MayV]

What could cause chest pain that has the symptoms of a possible heart attack but isn't that? Ten years ago, when I was 38, I was teaching a class when I got excruciating, constricting chest pain. My left arm tingles, and my jaw had the same terrible pain and it felt "locked up." The "attack" lasted 5-10 minutes. My jaw hurt for days, and my chest and ribs felt sore, as well. When this happened, a coworker took my pulse and it wasn't even fast. At the time, I was very fit, worked out with a trainer several times a week, commuted by bicycle, and had fabulously low blood pressure and resting pulse rate. I never had pain or anything like this while exercising, only while doing normal things like reading the mai or folding laundry.

At my next physical (after the attack), my doc did an ECG and said everything was normal. I've had an ECG every year since, all normal. My primary doctor declared this an anxiety attack, even though I was never feeling anxious any time these attacks hit, and I didn't have shortness of breath, dizziness, panic, sweating, trembling or other anxiety attack symptoms. Just squeezing, crushing pain.

These attacks seem to come out of nowhere for no reason. In the ten years since the first attack, it has happened 3-4 times a year, but not with the same intensity of the first attack. If it's not anxiety or a cardiac event, what could it be? I'd like to have some suggestions to take to my doctor when I go for my next physical.

[ireneo]

I wonder if it could be vasospasms. In some people the blood vessels constrict, reduce blood flow to the heart muscle and cause significant pain. I don't know a lot about it so you may have to look up more information.

[MayV]

Thanks for the comprehensive information. I had already read all about angina, but since there's no history of heart disease in my family, it seemed to me that this wasn't the answer. My primary care doctor is aware of this, but is unconcerned. He has written it off as an anxiety manifestation.

Isn't plaque the end result of a cholesterol problem? I am a vegetarian and have been for a very long time. Given the low, low cholesterol and saturated fat intake that are normal for me (along with low BP, low resting pulse rate, and very good heart-rate recovery in fitness tests), and the fact that I was very fit and active when this started seems to make angina unlikely.

Hmm. It has never happened at night or when I was sleeping. It's mostly a mid-morning to late afternoon event that seems to occur apart from any meaningful trigger (stress, meals, anxiety, exercise, lying down, etc.). It's just BAM!--out of the blue. And it hurts a lot.

Unfortunately, it's pretty much impossible to see a doctor right away like when an attack hits, and I will never be able to afford an ER visit.  I guess if my doctor isn't concerned, I shouldn't worry, either. It's been going on for ten years and I'm not dead, right?