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46 yr old - after Echo Stress Test

I am 46 yrs old, 230 lbs, athletic body, run 3 miles 3 times/wk. I am in decent shape.  Last week I started to get discomfort in my chest.  Not always in the same area sometimes on the lt side and sometimes on the rt.  At times its breif twinges and other times it stays for a minute or so.  It occurs both when I am sitting or moving, activity does not seem to increase its pain.  When I run the level of pain is not more or less and I am still able to complete my runs. However, I have noticed lately that I am very tired at night and I have been falling asleep much earlier than normal.  I have not noticed any shortness of breath, get a little winded after climbing 4 fls of steps, nothing unusual

I take Simvastatin and Lisinop/HCTV for BP and cholesteral.  BP stays pretty stable at 118/78, .
sometimes spikes to130/90.Cholesteral total is 178 and HDL of 48

Since I was having the chest pains I went into my GP and he ordered a stress/echo test.   I had the test yesterday and it took me about 14 min to get up to my HB range.  After the test the DR indicated that the images were very clear and that the heart looks perfectly normal

A little past history concerning my heart:  2 yrs ago I has a Cardiac CT for Calcium test completed and all but one of my arteries scored a 0, 1 had a score of 8.  In addition 10 yrs ago I had a nuclear stress test completed as part of a physical and it showed an abnormality.  So I had a heart cath. done at that time.  The test showed no blockage anywhere, the abnormality was that "the left main trunk was very short, almost nonexistent"

So all my tests have been good to date.Why do I still have these sporadic chest pains?

Do I need additional testing?  I know that the Echo/Stress test is about 85% reliable and only picks up blockages over 50% so is this accurate enough?.  So what other test should I be asking my DR for?  Should I be asking for a heart cath?  I would like to rule out that these pains are not from my heart
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469720 tn?1388149949
What is your height. There are a number of reasons for chest pain including musculoskeletal causes. The fact that your discomfort is not on exertion IE at rest is more consistent with non cardiac source. What is equally important to the anatomic lesions is the systemic risk factors for heart disease including your low HDL. I would use your concern to motivate life changes that reduce your risk factors. If you refer to a website optimalhealthtoday.com you can see cardiac risk assessment using cholesterol micro fractionation. There are a number of parameters to accumulate your risk assessment  Summary, your chest discomfort seems unlikely to be cardiac but unless you are 6'7" you may be greater than your ideal Weight.
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