atypical chest pain

[dona__0__0]

  I am a 50 year old female with a very strange chest pain. Some sx are very
  typcial of angina, some very atypical. It occurred for the first time when
  I was 20 years old shoveling snow.( I had also been thrown from a bucking
  horse onto my right shoulder several weeks previously, if that is significant)
  The pain was quick and sharp radiating from the front of my neck to the
  back just over my shoulder blades. Since then it occurs irregularly but
  increasingly as I get older.
  The pain is greatly provoked by heavy meals, cold wind and high elevations (making me
  (but not emotional exitement) making me very suspicious of coronary pain. I am a
  nurse so I am very aware of the paramenters of the problem.
  I can feel it coming on usually with a sense of tightness in my chest
  and right shoulder.
  The pain will be quick( less than2 seconds) but the tightness continues. I
  have had EKG's, a treadmill test while I was pregnant 12 years ago,
  and a ultrasound but they are all negative.Docs have never come up with an
  explanation but it restricts my activities so that I would like to find out.
  My family history is remarkable for my mother having significant CV problems.
  she is 72 and has had 2 bypasses, but was a chain smoker all her life.
  My father is 83 and in good health except for mild hyptn.6 sibs healthy.
  I have never smoked and have no other significant health history other than
  congenitally low cholinesterase and a lung function of 70% predicted for
  no known reason.
  This problem affects my life greatly...I am afraid to go into the cold,
  into a cold wind or any elevation because of the pain. With the
  pain I do have occasional rhythm irregularites. There is no sweating or
  nausea. The pain has occurred twice while I was just bending over.
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Dear Donna:
I am not sure what is causing your symptoms.  I doubt the problems at age 20 were related to your heart; if they were, some serious complication would have developed by now.  However, in the intervening 30 years, you could have developed heart disease.  You should get a thorough medical evaluation by an internist.  After that, an exercise stress test might be a good idea, if only to provide you with peace of mind.  If you do get a stress test, it would be best to get it with an imaging modality, such as an echocardiogram.  You mention rhythm irregularities, so a Holter monitor might be useful.  The symptoms brought on by cold might be an indication of asthma, so a complete set of pulmonary function tests may help clarify the situation.  If the sharp pains are related to the accident you had while younger, the cause of the pain may be neurological (this would not explain the symptoms brought on by the cold), and an evaluation by a neurologist may be useful.  If the above extensive evaluation is unrevealing, psychosocial causes for your symptoms should be explored.
Good luck.  I hope you feel better.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.