Tests Needed???

First, thank you for this forum. Here is my situation.  I am 43 year old male. No family history of heart problems. Weight is now 190, down from 240 a year ago. Blood pressure is normal. Cholesterol is 140 without medication.
Three years ago, I had a Stress Echo test, results were normal. A little over 2 years ago, had Nuclear Stress test. This was done due to ongoing chest pains. Nuclear test indicated possible problem, so cath was done. Cath came back normal and was told that issues were not cardiac related. Began extensive exercise program to lose lbs.
Today....still suffer from chest pains. Also, have been experiencing heart flutters/rapid beats. In addition, on occasion(once a month or so), experience a deep, sudden pain in center of chest. This pain only lasts for couple of seconds, but it is intense.
At my last doctor visit, he indicated that the pains seemed more muscular in nature. At last cardiologist visit, described the pains, especially the deep pains and he seemed not concerned. He felt that, based on cath, it was highly unlikely cardiac related.
Questions:
1-Are there any other tests I should consider or request?
2-Given my testing history, would you consider the ongoing issues to be cardiac related?
3-Does the quick resolution of the intense pains make it more likely not to be cardiac related?
4-Should I do any testing related to the heart flutters?
5-If I showed up at Cleveland Clinic with this history and these symptoms, what would you suggest?

Thank you for your help.

[CCF-M.D.-MJM]

Hi DucksHockey,

congrats on the impressive weight loss.  If your chest pains are from endothial diysfucntion, you are doing the best thing you can do by losing weight.

1-Are there any other tests I should consider or request?

a holter or event monitor is probably the best thing to evaluate the fluttering.   There are invasive tests to evaluate for microvascular obstruction in the coronary arteries, but my preference would be to treat you for them empirically rather than take you back to the cath lab.

2-Given my testing history, would you consider the ongoing issues to be cardiac related?

They did not rule out microvascular disease as a cause for the chest pain.  It could also be coronary spasm.  But again, these aare usually confirmed through invasive testing.

3-Does the quick resolution of the intense pains make it more likely not to be cardiac related?

The occassional brief, intense pain does not sound cardiac.

4-Should I do any testing related to the heart flutters?

holter or event monitor

5-If I showed up at Cleveland Clinic with this history and these symptoms, what would you suggest?

The choice of stress testing is always based on the person, but you would probaby get a stress thalium test if your symptoms sounded convincing.  If that was positive, you would probably have a catheterization with testing to diagnosis major epicardial blockages and if that was negative, you would probably be tested for spasm and/or microvascular disease.  That is probably what would happen.

I hope this helps answer  your questions.  Good luck.

[DucksHockey]

Few things to add. I am a non-smoker. Most of the weight loss has come about due to intense exercise, cardio and weights. The chest issues do not seem to hamper my ability to do my work-out, nor do they occur or become severe during my workout. I am able to do my 45-90 minutes per day of exercise with no real chest pain. The intense pains seem to occur more often when I move or change positions. The normal chest issues, which have been occurring for a long time, can happen at any times, but exercise does not seem to trigger them.

[Art S.]

Ducks, your symptoms are very similar to mine. Lots of weirdness in the chest but every cardio test you can think of and nothing really wrong (I do have pvc's and pac's but I have learned to live with those...)

Turned out that I had acute acid reflux disease. I had an EGD done and the doc found some spots on the lung that were not cancerous and have been taking nexium the last few months to knock all that out. I'm not a doc, but don't rule out gastro problems and go see a GI doc. Among other things, I have a bottle of "grasshopper", a neat combo of lidocaine and a maalox-type concoction and an anti-spasmodic. Haven't been back to the emergency room since the gastro doc set me up with that. Shuts the esophagus right down until the pain/quivering go away.

Good luck in dealing with your symptoms. Many of us here on the board in the same boat you are in.

Regards,

Art S.