That very elevated D-dimer
is concerning; one of the possibilites that has to be considered is an autoimmune or rheumatologic disease causing inflammation and perhaps clotting in other parts of the body (eg. such as lupus with lupus anticoagulant
); these collagen
vascular diseases can have chest pain
as a manifestation as well. Again, this is just one of the many possibilities in your puzzling case.
Dr Brenes-Salazar MD
Mayo Clinic MN