unstable angina

A very fit 20 year old friend of mine is experiencing cardiac pain radiating down his left arm. He was diagnosed with SVT. Although he has had a couple episodes of 170 plus heart rate his most dominating symptoms are intense pain leading to collapse and instant extreme fatigue
ER ECG's are normal, BP is up. Pulse 100-115. Blood enzymes were normal
Echo was normal Stress test normal chest xray normal
NitroG was given and takes the pain to a more bearable level only to be followed by a more intense episode.
Can anyone point me to a website that might be helpful?
Just as a side note this pain started 2 years ago and seems to be worsening. Between episodes he is a normal active 20 year old

[Jerry_NJ]

Sorry I can't offer any specific knowledge other than I have know people who have heart pain and take nitroglycerin (I believe it is) to relieve the pain.  The one person I recall was older than 20, but was just middle age when he had that prescribed.  He said he also has some heart rhythm problems but does not take any treatment for those.  

[erijon]

Angina in an otherwise healthy 20 year old male is EXTREMELY rare, but it can happen. Angina comes from pain resulting from a lack if oxygen from poor blood flow to the heart muscle mostly due to blocked arteries although arterial spasms are also a possibility. There are two types, stable angina that comes on with exertion at a predictable level of physical stress. Unstable angina can some on at anytime, including at rest.

His age along with a normal stress test almost completely rules out angina, it would be very, very unlikely. There are other conditions that mimic angina and pain from cardiac causes that are more likely. Esophagitis is an inflammation of the esophagus normally caused by acid reflux. The tricky thing with this condition is that it stimulates the same nerve that angina does to cause symptoms. To further confuse the two, nitro will lessen the pain from Esophagitis and give the same relief one would get from angina.

Try looking up "acid reflux" or "gerd" on Google and you will see many sites devoted to this problem and all the side effects including  increased heart rate. It is very possible that when he is symptomatic he is developing some issues with anxiety which can cause all the issues you listed above. Most importantly, do any of his doctor feel he has a heart issue? He should ask about acid reflux and anxiety, it may be a pretty easy condition to control.

Hope this helps,

Jon

[Natalie64]

Thank  you for your input. In the beginning the doctors thought he might have reflux or esophagitis but the cardiologist seems to think there is a problem. I did a quick google and he doesn't get the basic symptoms of GERD.
When he is having an episode (there is no rhyme or reason to it) the pain radiating down his arm the fatigue after is intense.
I think there could be some high blood pressure and he was put on atenolol just last week.
When I have seen him during one of the episodes the pain is so intense he can't speak and it decreases over about 3-4 hours to bearable.
It was an ER doctor who told me he had unstable angina...I think she was trying to tell me in laymans language that he was having a cardiac episode that they couldn't explain.
Thanks again
Natalie