How reliable is a stress test for ruling out cardiac problems?

[ChasesGrandma]

My husband is a type 2 diabetic, 65-years-old with a family history but no personal history of heart disease. He has a history of acid reflux, but has never had actual pain from reflux in the past.  Medications are omeprazole, Lotrel, atenolol, metformin, Zocor, Lantus and Humalog. His BP is well controlled and so is his  cholesterol according to his quarterly blood work. His A1c is around  7. The first of February he had a spinal cord stimulator implanted for back and leg pain. Following the surgery he had some post-op issues was placed on 20 days of Keflex and 10 days of Cipro concurrently. Last Friday, at rest while eating, he had his first ever substernal chest pain. Went to the ER and was admitted for observation for two days. The entire time he was hospitalized, including the ER, he had a normal ECG, normal serial cardiac enzymes, normal nuclear stress test without provoked pain.  His telemetry was normal and he had no pain during his hospitalization. He was released from the hospital on Sunday. Tuesday, he had another episode of chest pain, again while eating, that began to feel progressively better as soon as he took Mylanta and totally resolved in about 30 minutes. Friday he felt the same chest discomfort but much more mild when he awoke in the morning.  He immediately took Mylanta and the discomfort resolved right away. In between these episodes he is entirely pain free whether at rest or doing activites around the house. He does not feel any radiation of this pain and does not get short of breath. The pain starts out mild and gets more intense and then eases off after he takes the antacid.  Incidentally, they gave him morphine and a nitro patch in the ER and it didn't seem to affect the pain very much. Is a normal stress test a good indicator that his problem is not cardiac in origin?  What would you recommend as a next step?  Thank you.

[ChasesGrandma]

Thank you very much for taking time to answer and for your reassuring comments!  These pains have been very scary for both of us.  We are seeing the PCP on Wednesday and will ask about a change in his omeprazole or perhaps an upper GI work-up.  

[kenkeith]

Blood test profile almost always rules out an acute heart attack.  An EKG is not a very good test chest pain.  The stress test is very good to determine if there is any coronary artery blockage causing pain.  If I remember correctly the relaiability is 97%

Usually, when chest pains are heart related, the pain develops with exertion and that would be stable angina.  More advanced condition, the chest pain, etc. happens without exertion and that is unstable angina.  A nitrate should relieve the chest pain if it is angina.

It seems a heart condition can be ruled out, and the problem may related to the digestive system.  Often the symptoms are almost the same as a heart syndrome.