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intermittent chest, jaw, arm and upper back pain
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intermittent chest, jaw, arm and upper back pain

Hi, I am a 41 year old female who has been experiencing intermittent central chest, upper back, left arm pain and a jabbing/throbbing pain which seems to be over my carotid artery in my neck.  The first time I noticed was when I tried to use my new treadmill. It forced me to stop after only a few minutes and I passed it off as being stress.  The next time I tried to use it, the same thing.  I also get the pain each time I walk or even as I do alittle house cleaning which happened two weeks ago, except that the pain didn't let up.  I went to emergency where they told me that my BP was 190/something ( I forgot) which was high considering it is usually only 130-140/ 90 ish.  They did many ECG's, gave me aspirin, took several chest x-rays during the course of the night, took blood work, put on a nitro patch, gave me 3 sprays of nitro and then the nitro drip along with Plavix and Metroprinol something and Heparin.  I was also admitted to CCU and the next day sent for an angiogram.  Luckily the angiogram was good, showing clear arteries but mild disease and ventricular changes.  I was released from the hospital with a prescription for Pantaloc.  The hospital called me and I went back yesterday to have an echocardiogram.  
I have been on the stomach medication for approximately 10 days and still experiencing the same chest discomfort and jaw pain. Absolutely nothing has changed, so needless to say I am still worried.  Is there a test that they can do to check to see if maybe there is a problem with my carotid artery that may be causing the symptons?  I would very much appreciated your thoughts regarding what may or may not be going on.
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There are cardiac causes of chest pain which are not related to simple epicardial blood vessel blockages, and are more difficult to diagnose. Things such as coronary spasm and microvascular atherosclerosis. It sounds that from the history that the pain is probably related to ventricular thickening which occurs because of your poor control of blood pressure during exercise. The pain develops because the thick myocardium cannot obtain enough oxygen during stress because of its thickness and very elevated blood pressure, and so you develop chest pain.
You need better blood pressure control, especially during exercise. Medications such as metoprolol and lisinopril or amlodipine are very effective in lowering the blood pressure.
There are also valvular causes of chest pain such as mitral valve prolapse which need to be ruled out via a TTE.
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