Potential Heart Problem

[JDS2805]

I will try not to make this long winded but I want to give as much detail as possible so I can get an accurate answer. I'm a 29 y/o male 5'7 185, I don't smoke and overall I've lived a pretty active lifestyle until the last year because of frequent sinus infections which have caused me a lot of fatigue. I was in the ER twice last week with chest pain and tightness and shortness of breath. Both my blood pressure was 150/105 but gradually would return to normal. The first time going in my pulse was in the upper 90s to low 100s but gradually returned to the mid 70s. The second time it stayed in the 90s which I've noticed that happening from time to time over the last month. At times my resting pulse will be elevated but then return to normal. Both times I had an EKG which showed some abnormalities which the doctors said can be common with more muscular people. Both times my blood work- CBC, Cardiac enzymes were normal. The second time I was at the ER I also had a chest X-Ray and CT Chest scan which were also normal. I recently had my cholesterol checked and my total level was 149- the bad cholesterol was 93 and the good was 36 which I know is a little low- the triglicerydes were 107. I followed up with a cardiologist and he's ordering an echocardiagram, a stress test, and I believe another scan. I had an echocardiagram when I was 21 for a job and it was normal. There is no known family history of heart disease. I'm still feeling some tightness in my chest and still feeling the elevated pulse at times. I'm still a young man with a family so I'd rather be overcautious just to be safe. What could the abnormal EKG mean?  And with my bloodwork, CT Scan, and X-Ray all being normal, if the echocardiagram, stress test, and other scan all come back normal, should I ask for an additional test or could I safely rule out any serious heart problems. The cardiologist said the next step would be a heart cathader which he doesn't think I will need. Thanks!

[JDS2805]

Thank you very much for the answer- I will ask the doctor about that condition. I did see an Ear Nose and Throat Specialist last year and I have a deviated septum and they were wanting to do surgery - unfortunatly my insurance refused to pay any part of it and we just couldn't affort the 4000 for the surgery- I will say that from last October-Feb I had quite a few- but since then I've only had one or two. Just another quick question if I may- I looked up the diagnostic testing for it and I've had the chest X-Ray and CT Scan and extensive bloodwork- if this were the case wouldn't it have shown up in one of those tests? Thanks!

[Cleveland Clinic]

ECG is a very nonspecific test and this is why often order echocardiograms. If your heart function is normal on echo and there aren't any valvular/structural problems, then the ECG is inaccurate in your situation and you should always mention that to your doctors and probably even carry a small copy of it with you at all times.  The fast heart rate in the setting of chest pain is not very concerning to me bacause you were anxious at that time. The fact that it goes back to normal when things settle down is reassuring.  Same goes for the blood pressure.  Finally, the cholesterol even though, not ideal would not cause a coronary problem in you this early so I would definitely not consider any catheterizations at this point.  The sinus infections worry me a little, there is a condition called Wegener's granulomatosis which can present with the above and chest pain and shortness of breath.  Tell your doctor about it.  

[JDS2805]

Few more points. I did also have some pain in my left arm the second time I went into the ER along with back/neck pain, and some minor indigestion. I haven't had any weight gain which I've heard is a common symptom of heart problems- still not sure if the fatigue is from the heart symptoms or the frequent sinus infections but it's been a pain since I'm so use to being active. Thanks for taking the time to read this- it's greatly appreciated!