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Having cardiac problems and chest pain towards arm, jaw and back. Decreased vision, holter monitor showing the arrhythmias. Treatment?

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Good day, I am a 34 year old male. I have had off and on cardiac problems since I was 15 when my heart stopped and I passed out for a moment. At 22 I had a season of chest pain which moved to arms, jaw and back-had an angiogram and nothing was found..As of 3 months ago I have been in the worst season of this. Five visits to the Emergency Room... All of a sudden i'll have bouts of chest pain which also moves to those other area of my body-sometimes short of breath but not gasping. Rapid heart rhythm, sometimes long periods when the arrythmias occur and some of them are tremendously painful as if a golf ball is being shoved through a straw. I get dizzy sometimes, my vision has decreased and I'm low on energy--I get chest pain combined with upper back between on on shoulder blades, jaw and arms also these pains occur on their own sometimes. I get tired easily. I don't understand. In the last two months I have had multiple ECG/EKG's, a stress-ecco test, a full chest Angio-CT test, a brain and neck angio CT test, thyroid test, cholesterol test, blood enzyme tests and a holter monitor. All of which show no signs of blockage, heart disease, damaged arteries or some other congenital defect yet the pain and fatigue continue. Sometimes at rest but often increase with excertion and decrease at rest. The only test showing anything was the holter monitor showing the arrythmias. However 99% of the time i can feel when these are happening because they cause specific pain and discomfort. I get the chest and other pains even when they are not happening. Could the tests have missed something? Where can I go from here? I'm taking Propranolol- beta blocker for the arrythmias and some potassium because of a slight deficiency. The medication helps with some arrythmias, not all but some--but not much of the pain--there are times when my heart seems to overwork doing the smallest things--I will literally just turn in bed or sit up etc. and it goes from 75bpm to 130bpm or stand and it goes to 160. Sometimes I feel week and light headed and a bit "less present" sort of weak with stars in the eyes. I haven't been able to work for over two months and also limit driving because of safety. What can I do now, who should I talk to. I'm interested in real answers and getting my life back--I'm a non-smoker(except about 4 cigars a month) but not for 3 months now, some drinking but not for 2 months now, coffee but not for 2 months now. Some hiding virus, bacteria etc. that is lurking in the cardiovascular system perhaps, some defect or damage we haven't seen?, a missed blockage, old sickness neurological--MS or other etc...possible damage from old heart attacks not known at the time?Other. My doctor is fantastic but doesn't know what to look for next. There are some things wrong and I don't know where to go for answers next--I'm in the Western Washington Seattle area. Thank you for any and all help with this.
Posted Mon, 28 Oct 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 3 hours later
Brief Answer:
More tests and follow up...

Detailed Answer:
Hi friend,
Welcome to Health Care Magic


If there are no clues and if the problem is still bothering to the extent of interfering with lifestyle, there is an advanced technique of investigation – Electrophysiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and hence not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation. There are other advanced treatment modalities - like ablation (thermal or radio-frequency), which could be done during EPS.

     The next step is TMT (Treadmill Exercise EKG) with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle.
     CT angio is non-invasive study for the anatomy. The gold standard to see the ANATOMY (structure) – is catheterisation and coronary angiography… It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary artery spasm, as a cause of the problem – may need to be specifically addressed here. Coronary arteriography is invasive / generally not done unless there are suggestive clues in TMT... but it is the gold standard for this.
     These will rule in or exclude the role of heart, if any, as the cause of your symptom…
     Still no clues! - We may have to look further – an endoscopy by the Gastroenterologist to look at the oesophagus and stomach / MRI of spine to exclude nerve root compression / Spirometry (lung function test) and CT of the chest to exclude lung pathology… / last but not least, Psychological assessment and assistance - it may be helpful, in some

Discuss with your doctor -

Take care     
Wishing all well
God bless
Good luck
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