Arm pain as the first sign of Angina?

[Eddie 14]

I'm 36 years old.  5'10" 220 lbs, and pretty athletic. I do a fair amount of cardio work.  Cholesterol controled with Crestor (10mg) Zetia, Fish oil.  Just 2.5 mg of Altace for BP.  Other than one grandfather who had an MI in his 50's my family history is great.  He was a heavy smoker and drinker.  I know I should loose 25 lbs, but looking at me I"m not "fat".

1.5 years ago I underwent a 64 slice CT and a Stress Test for chest pain.  I have a very high stress job.  Both came back clean as could be.

However recently I am developing quite a bit of pain in my right tricep primarily when exercising, when I'm under actue stress, and sometimes when I lay down.  Without getting personal it happened while I was with my wife so to speak last week.  I also can get a bit of pain on the exact same spot on the left side, but not that often, not that intense.  

Now, I get no, nada, zippo chest pain with this.  My exercise capacity is outstanding.  It's a cramping, charlie horse like pain about the size of a quarter in my right tricep and the farthest is radiates is to my elbow and armpit.  Never down to my fingers.  I get a tad bit of this on the left.

I can get it simply walking over about 10 minutes when I pick up the pace, or sometimes at rest.  Always when doing cycling after about 20 minutes.  Then the event with my wife.  It scared the hell out of me.  It hurts like heck.  It's a pulsing pain.  When I stop activity it goes away.  That said, sometimes it comes on at rest and I simply wait it out.  MUCH more often during activity or stress though.

Now, I understand risk factors a bit.  Given my lack of family history and good tests a year ago I suspect no one would do much more right?  I've tried Physical Therapy for this for a couple weeks now with no luck.  

I know that if you look hard enough, you can get tested.  But given my history, would anyone pursue further testing?  Please advise.

[Mukesh Garg, MD]

At your age and symptoms which are not typical of cardiac pain, the likelihood of having significant blockage in your heart blood vessels is low. If your symptoms persist/change or are worrisome for angina, you may consider another stress test or other form of evaluation in consultation with your doctor

[Eddie 14]

I should mention I used to get this occassionally the last year or so.  Rarely, but sometimes when swimming or biking.  All of a sudden in the last 3 weeks it's been nuts.  All the time I get this. The thing is I"m in good shape cardiovascularly now.