what test to do?

[oh_man_not_again]

Hello, this question is about a 30 year old male who has been having distressing chest pain which doesn't match the cassic cardiac definition of chest pain, in that it doesn't necessarily get worse with exercise and that the chest feels heavy or uncomfortable the majority of the time, but with exercise, unusual breathlessness and dizziness are the factors, where as the chest pains and lightheaded spells have been occuring more at rest or with normal activity.

His risk factors are from within the last 3 years...gaining 60 pounds with a poor diet, lack of physical activity, and heavy smoking.  He has had a normal echocardiogram, chest Xray, EKG, and the usual labs.

At this point, what has certainly been ruled out by the tests mentioned?   I was wondering what additional test could be the "final answer" about his cardiac health?   I was thinking of the stress echocardiogram or Cardiac CT angio.   Do either of these, or perhaps both, seem entirely reasonable at this point in your opinion?

[Annette Quick, M.D.]

I agree a stress test whether with echo or nuclear should be entertained. I would have the patient walk if possible to try and reproduce the symptoms but also consider O2 saturation monitoring with the exercise to evaluate his pulmonary function with this. With his tobacco use lung problems may also exist.    

[oh_man_not_again]

Would CT angio be just as good as a heart cath?