help please

[po123]

Hello Doc, I was hoping you could chime in before I head off to the cath lab.

30 year old male, no family hx of disease
on no medications
ex smoker, 50 pounds overweight (but I do exercise)
CTX, echo, labs..all reported normal
PT 14.7
INR 1.13
PTT 30
D dimer 110
Troponin I <0.01
Digoxin <0.2
ESR = 0
ABG showed PH of 7.46, o2 of 96.8
etc, etc

4 months ago, I started having squeezing / heavy / pulsating upper-mid chest pain. Sometimes the chest pressure is on the left just below the shoulderblade when I'm laying on the left side. I also have vague dizziness.  I can just be sitting down and suddenly the squeezing comes on, and later it gets better.  The symptoms wax and wane in intensity but are present about 90% of the time to some degree. The most confusing thing to me is that the symptoms never really get a whole lot worse during exercise (i ride my exercise bike for 30 minutes with a pulse of 150-165 easily), although the pain doesn't get worse during exercise I do have an abnormal intensity in the pounding of my heart (feels like it just beats with too much force).  The chest wall is not tender in any way.

Prior to the onset of above symptoms, I had been having very brief "episodes" where I felt confused, weak, dizzy, and my pulse would suddenly race.So, recently I'm sitting in the ER and the only equipment on me was the pulse ox and this happened, a split second after it started the alarm went off and my o2 showed 85 and my pulse probably went to 130'ish. Everything went back to normal 15 seconds later, including pulse.  Unfortunately I wasn't hooked up to the EKG during this, but now I know my o2 is dropping during those "episodes" (which have occurred 1-10 times per month for a few years).

Should I just suck it up and get the cath done?  Does it sound like atypical cardiac pain? Should I get a chest CT first to check for unusual causes of chest pain? Help please I'm so lost.

[po123]

Doctor,   I was fully awake when I  had to o2 drop......how can this mean sleep apnea?

[Douglas Bogart, MD]

The symptoms sound atypical and the drop in the oxygen could be due to sleep apnea and not cardiac.  A CT coronary angio would tell you if you have plaque in your arteries or any blockage and would save you a cath.  Likely you are OK cardiac wise.