some questions

[addictions101]

i am a 29 year old man who is 5'10  245 pounds, i went to a cardiologist about  my symptoms,  which are   a heavy and tight feeling in the middle of my chest up to my neck, which makes me feel tired and weak, and hard to get a refreshing breath of air.  I also get heart palps in this same spot, most of the time they are post-exercise palps but not always.      Sometimes I'll have a good day, or stretch of days when my chest isn't too tight, I have my energy back and I can breath really good.   But some days are so bad that I have a hard time even wanting to leave the house because of that and I'm so lightheaded constantly.    
There has been at least 3 occasions where I thought something bad was about to happen because I felt so weak, my heart was squeezing too hard, and I got very pale and clammy and nauseated, but it always passed.
Before all this started about 5 months ago I had a few occasions where I had a very uncomfortable yet vague pain that traveled around my chest/neck/upper back.    
The tests I've had have been nuclear stress test, echocariogram and xray of my chest.  And my labs were also normal.
There's a couple of things I was wondering...why did I not get a stress echo, should they have done this?   Since my other tests were all normal,  what should I get done now because this is def. not normal in any way.    
I will be doing an event monitor starting in a few days, but what else besides that should I get tested for?
I have though that if anyone can figure this out it would be a cardiologist, pulmonologist, or endo doctor in that order.  Should I see anyone else?

Anything u can add would be appreciated  thanks.
PS--Isn't constant or chronic lightheadedness a good indicator of heart problems or impending ones? especially since my labs were all normal?  I am just so lightheaded allll the time along with my other symptoms.

[National Jewish]

The tests you describe seem reasonable, including the nuclear stress test presumably to assess perfusion, which is the blood flow to your heart muscle.  There exists a wide variety of nuclear and non-nuclear tests.  The choice of tests depends on the information desired which, in turn, is based on the doctor's clinical evaluation.  The ECHO provides a great deal of information about heart valve appearance, heart valve function, the strength of contraction and effectiveness of your heart muscle.  You should discuss this with your doctor and ask directly if the combined information derived from these tests truly does provide all the information necessary to rule out serious heart disease.  Coronary artery disease would be uncommon at your young age, but not unheard of.

You should also ask if there is any evidence of pulmonary hypertension and if the diagnosis of recurrent pulmonary embolism, which is clots to the lung, has been effectively ruled out.  That would be a non-cardiac diagnosis that could cause you to feel pale, clammy and nauseated.  The cardiac monitoring should rule out any serious abnormal heart rhythms that could also account for these symptoms, even with an otherwise normal heart.   Basically, if your cardiologist indicates that he/she is satisfied that you do not show any evidence of any type of serious heart disease, you should consider consultation with a pulmonologist.

You should also ask your doctors if any of your chest discomfort might be on a muscular basis.