chest discomfert

[hobss57]

I have had for the second time in three weeks a feeling in the middle off my chest like  your swallowing somthing hard, it gos down the middle of my chest then is gone in a second. Both times I felt fine before hand; after the first episode I felt fine, the second time I toke a deep breath and felt a slite pain in my lungs. This also was gone right away,but I didnt feel well for about 20 minutes. Then I was fine [ could have just been scared ]  Went to the doctors after second time , I was just over a flu bug  this was in the restproteary area, so he belived this was the cause.He listoned to my lungs an felt for discomfort in that area, every thing was fine. he also ran a ekg witch was also fine. I was sent home saying I was fine and not to worrie it is not heart related . Well I am worried , I am 50 years old on blood presure meds [under controll] and over weight. what do you think help signing off hobbsy

[Michael J. McWilliams, M.D.]

I agree that it doesn't sound like cardiac chest pain.  Cardiac chest pain is associated with exertion, stress, sometimes emotion and improves with rest or relaxing.  It is almost never fleeting pain and is rarely sharp stabbing pain.  From what you wrote, it does not sound like additional testing is necessary.  The reason is that if you do a stress test on someone that has a low probability of having blockages or coronary disease, the rate of false positive increases.  If you have a positive stress test, the doctor has to decide if the believe the result or not.  If you wouldn't believe the result (false positive) then it isn't worth pursing the test.  Essentially your doctor has said that he believes that your probability of a positive stress test actually meaning that you coronary disease is low enough that it doesn't justify ordering the test -- they wouldn't believe a positive stress test.  I know this is complicated and difficult to undesrtand, but this is the logic used in deciding whether to order a stress test.  If a positive test wouldn't change the treatment (because the doctor wouldn't believe the positive test), don't order the test.

Does that make sense?