23yr old with recurrent chest pain

[PFriend1]

My son is 23, healthy, non-smoker, non-drug user, occasional drinker. He has been having recurrent chest pain that sometimes radiates to his left arm and left side of neck. Usually, these spells aren't too bad, but sometimes they are severe, causing him to be just wiped out the next day, with no energy and dark circles under his eyes. He had has syncope twice, but these 2 episodes have been 3 years apart.

He has had EKG's, ECHO, TEE, Stress Test, and CT Angio. All these are normal. CPK's, and Troponin's normal. Lipid profile normal.

He normally runs B/P's of 90's/50's, with pulse in the 60's. When he passed out last month (only the second tiem to do this) and went to the ER, his pulse kept dropping into the 40's, with B/P in low 90's to high 80's over 50's.

The Cardiologist just started him on Lopressor 12.5mg at bedtime, said it should help the pain. He has also mentioned doing a 30-day Holter Test and a Tilt Table Test.

Is there something we are overlooking? What other tests should we ask for? Should we see a Musculo-Skeletal Phys.?

I know this is going to sound kind of strange, but I can't help but wonder if things aren't interrelated. When my son was born, he was a "Blue Baby". He had to be pushed out because the umbilical cord was only about 6" long, preventing him from dropping, but causing his heart rate to drop into the 60's during labor. Then when they cut the umbilical cord, we were told that he only had one artery in the cord, instead of 2 and that a sample of the cord would have to be sent off for further analysis. He was also born with a birth defect, Hypospadias, which we were told could lead to problems later on with his kidneys (don't know how, though), and that he may have missing vessels because of this. He's never had any related problems from all this, that I'm aware of. I know that this info is probably useless, but I feel like we've run into a brick wall and don't know how to get over it.

Thanks for any advice.

[Douglas Bogart, MD]

It looks like the evaluation from a cardiac standpoint has been a good one and so far there is no evidence of structural heart disease.  It would be unlikely that a congenital heart defect has been missed.  A tilt table and an event monitor might turn up something in terms of the cause of the passing out and are tests he should do.  

[PFriend1]

Thank you. We will call to set up the monitor this week, and hopefully will find out when they want to do the tilt table.

I think I'm just frustrated, and scared, because he's so young, and we don't want to find anything, but we don't want him to continue to hurt so much. It also scares me to no end to  think that he could be driving with his new baby, and pass out, although that has only happened twice, but both times have been without warning.

I appreciate you taking the time to reassure me that everything is being done right.