severe chest pain, normal cardiac eval

[Rob2008]

I'm a 31 yr old male who keeps having episodes of severe upper middle chest pain which radiates into the throat and occasionally the back.   It feels like a bee is stinging me deep inside my chest and the pain radiates to the aforementioned areas... there is no squeezing or crushing but this pain tends to come on and last maybe 15 minutes to an hour then it dies out and my chest just feels like it has a lump stuck in it..     I have actually tested to see if it'd get worse and walked up 3 flights of stairs,  it did not get significantly worse,  but the pain is bad enough to stop me in my tracks and is disabling when it is there.   The pain is quite specific and in the same place each time.   No SOB,  no other major symptoms.      Normal stress test,  chest xray,  echocardiogram,  SED rate 0,  normal upper GI xrays...what's next?

[National Jewish Health]

The pain you have experienced is not typical for coronary artery disease and this is supported by the normal stress test and your experience while walking up stairs.  Nor is it typical of pleurisy and such pain does not originate from within one’s lungs.

Two possibilities that come to mind:  1) that the pain is due to nerve compression such as at the nerve roots as they exit the bony spine often associated with degenerative disc disease; and 2) that you could have such pain due to an abnormality of the great vessels, the large blood vessels that enter and exit the heart, most notably the aorta.  An example of such is called coarctation of the aorta and your hypertension with a wide pulse pressure would be consistent with that diagnosis with blood pressures taken in the arms.  If you have not been evaluated by a cardiologist, you should be, with the preceding in mind.

The other possible cause of such pain, one perhaps associated with the feeling of a “lump” in your chest is severe esophageal spasm, for which there are many causes.  If the cardiologist deems the diagnosis of coarctation to be very unlikely, the next step would be to have your esophagus evaluated by a GI specialist.

Good luck.

[Rob2008]

I was wondering,  could I have something like an esophageal cyst and the chest xray miss that?   How often would chest Xray miss something like that?  Should I have a CT?

[Rob2008]

PS.   one thing I have noticed is that in my last 2 doctors visits my pulse pressure had been as high as 70+    but with home monitoring it ranges from 35-50 most of the time