Cardiac or Stress

[LuvToHike]

I'm confused... I started getting chest pains a few months ago when I was under bit of stress.  I had an upper GI series and it was negative for GERD.  I was given nitroglycerin to see if that would help the chest pains.  It did.  Now, I was just put on a beta blocker, nebivolol (or something like that) for a rapid heart rate, and a high BP reading at the time.  My BP is usually fine.  I had an echocardiogram and everything was fine.  Here's the confusion... I have no idea what is wrong with me, if anything.  The doctors don't provide any diagnosis or give any clues to whether there is anything wrong at all.  How can I know if there is something wrong or if I'm just stressing out and getting chest pains that are not cardiac in nature?  It seems that they only occur when I'm under a lot of stress.  This happened 6 years ago as well, and the pains eventually went away when I left that job.  Any suggestions?  The beta blocker seems to really alleviate the chest pains, and regulates my pulse nicely, but it brings my BP down to around 100/60 as an average.  But sometimes I get some very heavy chest tightness if I laugh hard or exhale to fully.  Scary stuff.  At this point, I'd like to know one way or the other whether there is something wrong or not, so that I know how to get on with my life.  Is it "only" stress or cardiac?  Should I continue taking the beta blocker if it may not be cardiac at all?

[NTB]

Sorry, I don't know. If you looked up "variant angina" you'd likely zero in in what you want to know.

AFAIK, they can give a "challenge" chemical before a scan to test for spasm.

In the end, if it's not an atherosclerotic  blockage, then it might all come down to endothelial dysfunction and lack of Nitric Oxide.

[LuvToHike]

Thank you both for your feedback.

Encephalomalcia, I do wish to know what, if anything is actually going on, however, I don't get any real answers or suggestions for additional testing.  My BP at the time the doctor prescribed the beta blocker was 150/80, and the pulse rate was "beating a mile a minute" (no number given).  When stressed my BP has been as high as 190/92.  But it usually goes down to below 130/80 within an hour or so.  As for B complex... I've taken them and they make me sick to my stomach.  I can't even take regular vitamin pills; I have to take chewables.  Go figure.  

NTB, As for the beta blocker... I do feel less effects of stress while on it, and therefore better I guess.  I just don't like the idea of treating a symptom without knowing the cause.  It may just end up masking a problem, or on the other hand, preventing an imminent one.  If it is just stress, what would a scan show?  I'm guessing It can probably only identify clogged arteries.  I had a nuclear stress test 1.5 years ago, it came up negative.  The chest pains I was having then, eventually went away and just recently came back again.  Since I started the BB, I haven't experienced them much at all.  I just want to know what the cause is so I can make the necessary changes in my life.

[NTB]

> Is it "only" stress or cardiac?  

that's a difficult thing to know without a scan of one kind or another, to look at the coronary arteries.

btw, nebivolol is a vasodilating beta blocker, so it relqaxesz arteries just as nitroglycerin does. But are the arteries not passing enough blood flow because they are blocked with atherosclerosis or because they are constricting under stress? Or both? My guess is that only a scan can show that.

[Encephalomalcia]

If you do not have a blood pressure machine, I would get one and start taking your blood pressure three times a day (if you can) three times each.  Record the blood pressure in a booklet.  Record your heart rate also.  I do not know how fast your heart rate was or how high your blood pressure was when your doctor prescribed the beta blocker.  If it were me, I would want to know exactly what is wrong before taking beta blocker and nitros.  Nitros are bad for the liver.  If stress is causing your symptoms, you might want to try a vitamin B stress complex.  It really does help calm.  It could be that you are lacking the B vitamins from your diet.