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Recurrent chest pain, stress echo normal, high cholesterol, borderline BP, family history of arrythmia. Where do I go from here?

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Cardiologist, Interventional
Practicing since : 1998
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Im a 29 yr old white male. My brother died at 35 with autopsy stating reason of suspected cardiac arrythmia. He had stated in years before having chest pain off and on with clean cardiac workup. Now i have the same. Reccurent chest pain. Like pressure squeezing. Usually lasting 5-10 minutes. Lately happening at rest. I had a stress echo and was told
Its normal. What now. My cholesterol was a little high so dr started me on statins. And bp was borderline so started me on lisinopril. Thought it might be anxiety so started celexa. Thought it might be gerd so started prilosec with no help. None have helped chest pain. Im overweight but i eat healthy and do not drink cokes. All the rest of my bloodwork was normal. No diabetes. No other health problems. Chest pain keeps coming and feels like getting worse each time. Pain doesnt change with position or breathing and doesnt go away with rest. It just happens then after 5-10min goes away. I dont want to suffer the same fate as my brother. Where do i go from here? YYYY@YYYY
Posted Wed, 25 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 15 hours later

Thank you for posting your query.

In my opinion when we say the death due to arrythmic cause its more of exclusion than conclussive unless some other corborative evidence.

Now coming to your case, stree echo being normal is a good sign but doing holter is good idea.

Have your ECG looked at to rule out QT prolongation and hypertrophic Cardiomyopathy.

If there is any doubts its worthwhile to do MRI of heart. If evrything is normal there is nothing much to worry.

Secondly is there a family history of sudden death other than your brother? If so you might benefit from genetic counselling and electrophysiologist opinion.

Hope I have answered your query. Please write back if you have additional concerns.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Recurrent chest pain, stress echo normal, high cholesterol, borderline BP, family history of arrythmia. Where do I go from here? 6 hours later
I had an ecg when we first started testing. It was normal they said. About sudden death only my brother at a young age. My father had his first heart attack around 40 yrs old. And my grandfather died of sudden heart attack.

Upon re reading autopsy report of brother. It says he had a hypoplastic right coronary artery, remote infarction and probable cardiac arehythmia.

1.About my case would an MRI show something that echo would not?
2.If im not having pain at the exact time of mri would it still show anything?
3. If the MRI is normal what could be causing this pain that is exactly like cardiac pain. After all meds for every other cause i still get pain.

Thanks for your help.
Answered by Dr. Prabhakar C Koregol 8 hours later
Thanks for reverting.
As I had mentioned earlier, an arrhythmia is only an assumption in your brother’s case. The right coronary can normally be hypoplastic in people who have what we call the “left dominant system” ( a condition in which one of the arteries namely the posterior descending artery originates from the circumflex artery, a branch of the left coronary artery). If there is such a strong history of coronary artery disease (heart attack) in your family, it would be better to perform a computerised tomography coronary angiogram.
However, to answer your question, the magnetic resonance imaging scan (MRI scan) would show an abnormality even when there is no pain.
We would need a CT coronary angiogram to be normal to reasonably be assured that the pain is non-cardiac in origin. Other causes of chest pain could include costochondritis, peptic ulcer disease, gastroesophageal reflux disease amongst others.
I hope I have answered your query. Please accept my answer if you have no further queries.
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