Unexplained chest pain

[dncer]

Good Morning!
My question is about my husband's health.  He has a history of chest pain dating back to 1995 had extensive cardiac work-up at that time, incuding cardiac cath, and all was found to be negative.  (Since that time he has been followed by a cardiologist every six months for an hypercholesterolemia and has been on Lipitor)  Since that time (15 years) he has been asymptomatic until Feb-Mar 2010 he started out with a bilateral ear infection, was given a Z-pack and symptoms resolved.  Two weeks later he contracted a GI virus and had severe diarrhea and vomiting for 48 hours.  Several weeks after that, in April, started complaining of shortness of breath and irregular heartbeat and sought medical attention and had an episode of acute chest pain, bradycardia and was found to be in A-fib.  At that time he had a cardiac cath with showed moderate blockage of the LAD and ultimately underwent a single bypass, MAZE procedure and pacemaker insertion.  Post op course was normal, with good recovery.  July 2010, 3 months post bypass, developed severe chest pain was still in A-fib with an EF of 35%.  He underwent a transesophageal echo for possible cardioversion and was found to have a clot in his left atrium, which is still present.  He again underwent cardiac cath however the blockage of the LAD was no longer present.  Since that time has two episodes of V-tach which resulted in an upgrade of his pacemaker with ICD placement and he was started on amiodorone.  He was shown to have primary hyperparathyroidism and had a parathyroidectomy.  He has had an elevated ANA and possible diagnosis of anti-phospholipid syndrome but still no explanation for continued episdoses of severe chest pain.  Other than elevated ANA,  testing has been normal.  (Anticardiolipen antibody studies are pending)  More recently he has had an acute onset of bilateral shoulder pain and left knee pain, all which came on suddenly and resolved just as quickly, within 24 hours.  He is on the standard cardiac meds, Toprol, Imdur, Lasix, Lisinopril, Amiodorone, coumadin.  Each episode of chest pain starts with a "weird" feeling that he can't explain, with diaphoresis and escalates to a 10 on the pain scale.  The pain is relieved over several hours with SL nitro and IV morphine in the ER.  The episodes are sporadic and have not been associated with any one contributing factor or activity.  My question is any ideas for what may be causing the chest pain?  He is being treated at a top-ranked hospital in the nation and we still have no answers.  Thanks for your input!  :-)    

[dncer]

Thanks for the feedback!  They haven't ruled anything out at this point.  His activity is no idicator for the chest pain and he too has been awakened from a sound sleep by the pain.  They did have him on a ccb and he also carries the nitro with him but it doesn't take the pain away completely, he always needs some type of analgesic before he is pain free.  He's on the highest dose of isosorbide.  It is good to hear your history because this whole thing seems so surreal.  This is the stuff that happens to other families.  I guess we are now the "other family".  Thanks again!  :-)    

[ChatterAlly]

Wow, sounds like he is really going through so much.  Just want to add this.  I was recently diagnosed with coronary artery spasms.  These chest pains are very much like the chest pains I had with my heart attacks.  But the doctors do not always consider these as the problem.  There could be some small vessel spasms that are causing his chest pains.  The one thing about these spasms, they can wake me up out of a dead sleep, and at times certain positions I lay in bring them on.  Never triggerd by any exertion. Just something to consider. He has gone through so much already.  I take a calcium channel blocker to keep mine under control.  It took a month or so to get the full effects of the ccb.  I always carry nitro with me and take isosorbide (long acting nitrate)daily.  The chest pains are always relieved with nitro.  Take care and keep us posted, Ally