24 yr old with angina??? and PVC's and other weird rhythm's

[cookienkikin]

im a 24 yr old male. cholesterol 245, ive been having this left side chest pain for about a yr now. ive had echo,ekgs,stress echo,holter monitor, event monitor, and blood work. i also have been experiencing pac's and pvc's. all my test were normal besides the event monitor which showed the pac's and pvc's.I have left side chest pain that is intermittent and everyday, radiates to my left arm, left hand, and left jaw, sometimes i will get nasueus and really hot with it and sweat along with shortness of breath. I cannot reproduce the pain by pressing on the area. I know this seems just like typical unstable angina, but I had them normal test results. I have a few questions here if you could be so kind to answer i would greatly appreciate it.    1.N-terminal pro-B-type natriuretic Peptide predicts significant coronary artery lesion in the unstable angina patients with normal electrocardiogram, echocardiogram, and cardiac enzymes. Does that seem like a good test for CAD that you know of??   2.Can someone with a normal stress echo, bloodwork, ekg, echo, and cardiac calcium score still suffer from unstable angina that was missed? (please explain your opinion)   3.My Dr. says that I've had all the normal test for heart disease but I'm still having these symptoms (not heartburn, not chostondritis, not anxiety) what could it be? The chest pain is left sided, radiates to left arm, left hand and left jaw, shortness of breath, feeling really hot and sick. (ANGINA!?!?)   4.Do I need further testing such at heart cath (angiogram), is that the only test that sometimes catches angina in someone with the TYPICAL symptoms of it but normal test results at 24-25 yrs of age???   I also sleep like 12 hrs a night, always tired, VERY inactive person, get short of breath with LIGHT exercise.   5.With all the symptoms I have descibed and what I experience everyday what do you think the likely hood of the being unstable angina, or variant angina would be from your years of experience in the cardiac field??   Thank you SOOOOOOOOOOO much Dr. If you dont mind I would appreciate it if you could answer my questions in full detail. Thanks again!!!!"  also almost every morning i will be woken up by a weird feeling in my chest and my heartbeat will be REALLY REALLY SLOW with LONG pauses inbetween and hard to detect (weak)?  what could this be, anyone have that before?  thanks

[is_something_wrong]

It's really not easy to say (again, without an ECG), my first thought was bradycardia (slow HR) due to high vagal activity (the brake in your nerve system). It can also be PVCs, or some more uncommon causes.

I would recommend you to consult your doctor and ask for another Holter monitoring, just to get these things cleared up. Though a 12 channel ECG is better, Holter monitors can (as explained above) give certain clues about angina or not angina. If you had these symptoms during your previous monitoring, you can just ask the doctor.

[cookienkikin]

also almost every morning i will be woken up by a weird feeling in my chest and my heartbeat will be REALLY REALLY SLOW with LONG pauses inbetween and hard to detect (weak)?  what could this be?  every morning about the same time it will wake me up like that and sometimes be just really weird heartbeat.  thanks so much

[is_something_wrong]

Hi,

I'm not complely sure what to answer, I'm afraid.

You ask if someone at your age can get angina. The answer is yes, but it's extremely unlikely. Angina due to coronary artery blockings in your age is mostly caused by "familiar hypercholesterolemia" in other words, you have, from your birth, extremely high cholesterol (often >10 mmol/l or >380 by your measuring) with low HDL and high LDL.. It can also be caused by "variant angina", that is spasms in your coronary arteries, not blockings.

Angiograms are invasive procedures that involve risk. It's very uncommon to do at your age.

I'm afraid the only way to come closer to an answer is to be monitored with a 12 channel ECG while you have symptoms. Holter monitors and event monitors are not very useful evaluating angina (though they can give a clue)

You should make an appointment with your doctor, to go to his office if you have symptoms, to get an ECG done and evaluate what this is and isn't. It's also possible to ask him to give you some nitroglycerine, and see if your pain reliefs after using this.

Again, I'm sorry I cannot answer this question any better, I doubt even doctors can answer this without seeing your symptoms on ECG. Angina is unlikely, but your symptoms should be taken seriously.

[cookienkikin]

its TEN times worse the day after I drank alot, and like i stated the pain is JUST like angina, left side chest pain, squeezing, left arm pain, left hand pain, left jaw pain, get PVC's with it, hot flashes, not feeling well at all.  could this be angina in someone my age? is this unheard of? do i need a angiogram or the test i had suffecient?  i cant find a Dr. that will do a angiogram.  someone please help and give me some input, thanks so much to is_something_wrong

[is_something_wrong]

I'm afraid you won't get this question answered by MD's in this forum. You'll have to use the expert forum. Anyway I can give you some thoughts about this.

For stable/unstable angina, angiography is the only test that can rule out this condition by almost 100% certainty. A stress test has a maximum 80-90% specificity. Anyway, with a negative stress test, and a negative calcium score test, unstable angina is extremely unlikely.

You have some risk factors, your cholesterol is a bit too high and you are inactive. Do you smoke? Parents with heart disease? Blood pressure OK? Heavy drinking?

When do you get symptoms? Are they worsening with activity?

You mention variant angina (Prinzmetal's angina). This is a rare disease, but can happen in young individuals. It's caused by muscle spasms in your coronary arteries, not permanent blockings. It cannot be seen on angiography and rarely on stress tests.

I recommend that you discuss this further with your doctor. It's extremely uncommon for a 24 year old to have angina, but your symptoms are a bit suspect, and you should possibly get a second opinion.