daily chest pain esp with long distance running

I am 46 years old with complaints of continued chest pain.  I am physically active; running long distance (marathons).
I have recurrent chest pain.  frequently later in the day.
when i go out running, if I start to fast and run hills; I get the chest pain.  usually if I back off it gets better.  During a marathon race, the pain comes on later in the race and doesn't really go away, typically hurts mid chest radiating to my shoulder blades, up my neck.  kind of a crushing pain.  also during the marathon when the pain gets worse, I also get some palpitations--PVC possibly.  but those usually go away if I back off on my pace.  sometimes with the pain I also get a cough, and it hurts more with the cough.
I have had a very extensive cardiac workup.  I do have a S1. S2 murmur.  mild tricusp regurg, mildly thickened mitral valve leaflets,  mild thickened aortic valve (age related?)  
I have had echo, cardiac cath, nuclear studies.....no reason for the pain??  the pain didn't come on when i had the stress test....i guess they didn't challenge me enough?  my hr goes up to 140 and stays there for over an hour during my running, but does recover down to 70's  but occasionally will skip beats if I abruptly stop after running hard.
I have also had extensive GI workup to include endoscopy, colonoscopy, the test to check for esophageal spasm(cant remember what that was called) HIDA scan.  I am now starting to see and endocrinologist--i am mildly anemic. all other hormones were ok.

I have been living with this pain for over a year,  I sometimes feel like a hypochondriac and siince have not gone to see any docs....just try to continue with the pain.  my cardiologist did offer me Ranexa which did to seem to help some.  the pain wasnt as bad and my energy levels were more normal.   And I have some metroprolol that my doc prescribed that I try when the pain is bad and my hr is high enough (low resting HR of 40) it usually helps the pain.
thanks,
marti

[ChatterAlly]

One other thing they could look into is coronary artery spasms, or small vessel spasms.  These are harder to detect. They can be detected though if they are looking for them. There is a poster in here with a lot of information on this subject. She goes by the name of JoaninCarolina.  Have they suggested using a Nitrate for the chest pain?  I take the Nitro everytime I have the spasms and it works for me everytime.  I take a beta blocker and a calcium channel blocker for the spasms as well. I hope you can find something soon, Ally.

[Marti138]

Thanks.
I will look into the spasms as a possibility.
My cardiologist doesn't think it is my heart at all,  but I don't know what else it could be.
I have a low resting hr and cant take beta blockers, but have tried them and they seem to help some but my hr stays low along with my bp.
I am hoping it either goes away or it becomes more apparent so that I could move on.
I contiue to run, race in races, and the pain does come and I just run through it.  sometimes having to back off because it does scare me some.....but the paiin is the biggest symptom I get.  I still seem to run on?
Marti

[vienna13]

I am not a cardiologist, but common sense to me: if your heart behaves as you described, you should stop running immediately, this is my advice and opinion. Also your body is crying for that. Sometimes it is better if we listen what our body is telling instead of wanting   answers right away: what is that what we are having and how to measure it with numbers and name it with words. Especially if a diagnosis already was made and as your cardiologist stated: he doesn’t think it is your heart at all. In my understanding your heart is healthy. Still. You should not run. Also I am not saying you should not investigate more, what it could be, but do that while you are having a free time from running. If I was you I would walk from now and on.
     I was a runner (not professional). I was asked 7 years ago in the hospital “you were running with this heart?”That sentence stayed with me. I wanted to show no matter what I will do it again, when getting better and a year later started, very slowly 20 minutes daily. So I think you never should think  as a 'giving up', just taking a break…..you still very young and you will pick up running again don’t worry, but now your body asking you : stop! Take it as a well deserve break!
My best.  

[ChatterAlly]

I found this from the Texas Heart Institute while searching for more information on the pain of microvascular angina.  Thought you might want to read this also:

"New research has shown that cardiac syndrome X is most likely caused by a form of angina called microvascular angina. In microvascular angina, the small blood vessels in the heart (called capillaries) tighten or constrict. This tightening reduces the blood flow in the heart and causes the pain of angina. But because these capillaries are so tiny, they do not increase the risk of heart attack. They are also too small to detect with the standard tests that doctors would normally use to see larger vessels."

Some suggest that the reduction of the hormone estrogen may bring this type of spasm on, also.  Just giving this more thought for you.

Take care and keep me posted, Ally