Chest pain during exercise

[flowergirl2060]

I am a 48 year old female.  I have a strong history of heart disease in paternal grandfather and father.  Both died at an early age. I have had PACs and PVCs and IST for the last few years.  I have had echocardiograms, EKGs, stress tests, etc.

In the last month I have experienced chest pain that is localized around my left breastbone to the left of the center of my chest.  It usually occurs after 15 minutes of exercise.  I don't have shortness of breath or a radiating pain.  It goes away after I stop exercising.

My cardiologist did a stress test and found it to be negative.  I did experience the pain during the test at around 8 minutes with a heart rate of 186.

I've just had my cholesterol checked.

Total     174
HDL       58
LDL       98
Trig      104

I had a CT scan of my heart two years ago.  There was no calcification.

The cardiologist says that the pain is not heart related.  It could be chest wall pain or muscular.  I am having a flare up of arthritis in my fingers.

My questions are:

1)   With all of the tests that I have hae is it safe to say the pain is not from heart issues?
2)   How accurate are stress  tests and heart CT scans at truly picking up heart disease?
3)    Is there another test I should have?
4)    My cardiologist said to come back in six months.  Is this something I should press him about?

Thank you for your help.  It is greatly appreciated.

[GOTALIVE]

If you don't mind, I am not a Doctor, and as Dr Kirksey says you seem to be in pretty good shape.
I believe you could take a lot of the guess work out of how well you really are now and in the future by reading the book EAT TO LIVE by Dr Joel Fuhrman. I am a follower of his advice and I was more than 40 pounds over weight, high blood pressure, high cholesterol, which led to a heart stent inplantation in July 2006. On $4500 of medication on my release from hospital and fearful of my future health prospects. I was to say the least confused and  bombarded by all the online information regarding rehab etc. I got down on my knees and asked the Lord for help; and he did in a big way. With a search I placed on Google for : Life after stent. I found Dr Fuhrmans web site , I ordered his book. The past two years have seen my bill for Drugs down to $200 per year. My Cardiologist has had to lower 80mg of lipitor and multiple h/blood pressure meds as my numbers have come down and down. I am taking 10mg lipitor, and 2.5 mg amlodipine, and 5mg benazipril, and 325 aspirin. My blood pressure this morning was 110/64 slightly lower than the 122/68 which it has averaged for the last five months. Last week he told me I was doing well enough he only needs to see me in a year. My cholesterol which was over 260 at one time is now total 142 ldl 71, hdl 59. trig 78. What I ask you to consider is a life style change that will put your mind at ease,( especially like me you have the family history of heart disease). Through nutritional excellence you can prevent the heart blockages you fear you may have or are likely to have down the road. I have seen the book used for $ 6.00 on Amazon .com. I am an avid runner, ran a half marathon in Feb, and Long distance cycling, I am also at piece knowing I am on the right track. Thank you Jesus. All the very best to you,
                                                                 Brian Clark.

[Lee Kirksey, MD]

Sounds like  your in pretty good shape

[flowergirl2060]

I have had two stress echos in the past.  The last one was two and a half years ago.  Do I need another one?  They have both been good.

[Lee Kirksey, MD]

Hello
I appreciate your concerns given your family history. No test is perfect and we always try to use the overall picture including examination and test results collectively to determine the liklihood of a true problem existing. The question your asking: is it possible to have a false negative stress test? The answer is yes and statistics very from less than 5% to 15-20% in some studies of patients with underlying abnormal ventricular function and bundle blocks. In your case, you have had additional tests like the CT to confirm the results. However the CT was a calcium score and not an angiogram to determine the absence of blockages.

An additional test to be considered would be a stress echo.
Also if it is actually musculoskeletal discomfort, it should improve with nonsteroidal or other appropriate treatment which would also allay some of your fears

You need to have enough info to feel comfortable with the evaluation and physician impression that the work up is negative.

Equally as important is what are you doing to decrease your risk of disease including diet, exercise and are you on statin therapy