Chest Pain/Pressure Under Breastbone...Ideas?
I have been having chest pain for a while now. My Internal Med doctor really doesn't have an idea what it could be, he has never sent me to a Cardiologist because he believes that I am just too young to have heart issues (I am 35). I have a number of conditions (Addison's Disease, Postural Orthostatic Tachycardia Syndrome, Paraneoplastic Autonomic Neuropathy Syndrome, RSD, Occiptal Neuralgia) and I am on a bunch of meds (which include Prednisone, Oxycontin, Methadone, Nitro, Nadalol, Midodrine, Imuran...plus others). My father's side of the family has had a lot of heart issues...heart attacks, disease, etc. My dad just had a quadruple bypass at the age of 55.
I have been having TONS of pressure/pain/tightness right in the middle of my chest under my breastbone. The pressure is pretty constant and I have bouts of stabbing pain. I take Nitro which helps when the pain becomes so bad. The pain will go into my shoulder, the bottom of my neck and through to my back. It gets worse when I try to do anything strenuous (given my conditions I have not been very active)...it will be worse after I do the activity and am sitting down, when I go to bed and am laying down the pressure seems worse, it is also worse in the morning. I wake up soaking wet. My blood pressure is maintained with meds for my POTS and is generally lower (105/55).
One time I was going in for an IVIG treatment and on the way there I had the WORST chest pain ever. When I got to the appointment, I was dizzy, flush and it was hard to breathe. They took me straight to the ER. They gave me some nitro, which help a little. They took blood and it showed elevated levels of something to make them think that I had a Pulmonary Elmbolism. They did a CT scan, and it came back neg. They think that the Paraneoplastic condition I have makes those levels elevated. They gave me some Xanax and sent me home. The Xanax only made me tired and did nothing for the pain. They didn't bother bringing in any Cardiologist or suggest that I see one.
The chest pain got so bad the other day, I thought about going into the ER again. I just didn't think that I was having a heart attack though, so I decided to stick it out. Since then it has continued to be more pressure/tightness with more frequent episodes of stabbing pain. Because of this, I tried to see my Internal Med doc, but his calendar was full, so I saw my Family Med doc. I think that it was good to see him, because he thinks that I need to see a Cardiologist. I have an appointment tomorrow. He was going to put me on some channel blockers, but said that my blood pressure is too low already.
If they try to do a stress test, I can promise you I am not going to make it too far. I did one about a year and a half ago and because of my POTS I made it only a couple of minutes before I felt like I was going to pass out and ended up going off the back of the treadmill...my doc caught me. That test found nothing at that time...the only person that looked at the results was my Internal Med doc...I don't believe that any Cardiologist looked at the results.
I have had a numbers of EKGs. They do them as part of the pre-op exam. The EKGs have had minor abnormalities, but I was told that they were normal for a woman my age and nothing that I should be concerned about. Oh...I have had a Nissen Fundolipcation for reflux...and they fixed a hernia while in there too. I haven't had any reflux since my surgery (May of '08).
So, any ideas of what this could possibly be? Angina? Continued reflux? Anxiety? Heart Issue? I am just wondering if anyone can tell me if there is any specific things I should ask tomorrow at my appointment. What tests may they suggest and are they worth doing? Any help would be greatly appreciated. I want to go in a little informed.