hypotension, recurring cx pain

  I am a 37y/o white female with strong athletic backgound.  I'm an RN.  
  I have been dealing with very labile B/P's can be 70's/40's or 130's/90's.
  In the last week I've only had one day without cx pain that has required ntg x1.
  The cardiologist my primary sent me to, after being admitted to the ICU that I work in,
  was attributingthe low B/P's to IBS/chronic diarrhea, but . . . this has now been resolved
  My employer is concerned as am I!!! Since my GI doc cleared me in that regards
  I had an echo today that the tech said showed EF of 56 and the only thing she
  saw was a small Aortic leak.  What is normal EF for me?? What should I expect
  with these results. How agreesive should I be with seeking answers.  The cx pain is
  getting really old.

[CCF Cardio MD - MTR]

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Dear CCS, thank you for your question.  At age 37, it would be extremely unlikely for you to have coronary artery disease as the cause of your chest pain.  But, I wonder if you have had a stress test done to exclude ischemia as a cause.  The labile BP is unusual, but without knowing more about you, I can't determine what is causing this problem.   Your EF (ejection fraction) is normal at 56% and the aortic leak to me sounds like aortic valve insufficiency (AI).  The management and subsequent prognosis of AI depends on the severity of the AI.  If you indeed have mild AI, then all you would need is serial echocardiograms and possibly a medication or two.  As for the chest pain, it's hard to recommend something since I don't know what prior tests you've had done.    Perhaps you could write back with additional information and I could give you a more complete response.  
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