Question: Hi, I am a 46, almost 47 yr old male (12/20/67) who has been a heavy smoker for 20 years (1 to 2 packs a day)

I have a history of SVT, but that only occurred when I was in my late teens, and once in my early 30s. The last few years however, I have struggled with occasional bouts of sinus tachycardia, which increased in episodes the last few months. My doctor increased my atenolol from 50mg to 100mg per day. I take 50mg in morning, 25mg early evening, and 25mg before bed. I also take .25mm Xanax when needed up to 2 times a day. After also suffering from Neuropathy, the doctor has me on Gabapentin 300mg capsules, 3x a day. (the Gabapentin I have only begun taken the last couple of weeks.)

Since this increase in atenolol, I have had no episodes of tachycardia at all. (about a month now.)

However, about a week before Halloween, I worked very hard on a project with many long hours, etc. I started getting unexplained pain in my left arm, sometimes right arm, sometimes one or the other shoulder, or even both, sometimes my neck, and sometimes square in the center of my back, or even in lower ribs (both sides.) In the course of the last month, the pain has seemed to increased in its duration and times effecting me, but mostly stays in my left arm. It does not radiate from my chest... No real chest pain to speak of. The pain is a "deep" pain which feels dull sometimes, and other times “pressing.” It will “hit me” feeling the pain for a few seconds, then go away, but then keep doing that over and over, sometimes for a few minutes, sometimes even for hours. The pain comes more so, if I have worked all day, or have done activities. If I rest all day, I won’t get much. However, the pain will still come it seems at anytime, at rest or at work or activity. At nights, for the most part, it won’t wake me up, but once that did happen. No night sweats really (happen once in the last three weeks.) … but I have had a history of insomnia the last few years. Last night, instead of the pain coming and going for only a few seconds at a time, it seemed to stay intense of much longer durations.

It really seems I *don’t* have a diminished ability in terms of physical abilities. I don’t get short of breath walking up stairs, etc.. maybe a little, but nothing to speak of in my opinion. When I had my bouts of Tachycardia in the past, it was usually accompanied with sometimes sudden weakness or general not feeling good.

- I passed a stress test a couple weeks ago
- I passed a halter monitor (2 days worn) that only showed benign premature heart beats.
- I passed a cardiac catheterization in which they used XXXXXXX and put tube in my right arm. Everything showed normal.

Issues:
* I still have premature heart beats that scare me, but I’ve had them all my life too.
* I am still getting “unexplained” pain in my left arm and other areas as described above. (but, almost never in two places at once, but that can happen.)

My biggest problem is, my doctor thinks this may be all anxiety,. especially after passing all of these recent cardiac tests, but especially he said if I passed the cardiac catheterization, that was the “supreme court” to rule in or out any heart disease. The cardiologist who did the cardiac catheterization said my arteries in my hear were the best he saw all week.

My question is, Where do I go from here? I still worry I may die any day from a heart attack, due to what seems like cardiac symptoms to me. Doctor originally diagnose me with polymyalgia rheumatica a couple weeks ago, (thus the new prescription) but blood test for that came back negative.

My doctor even said himself he is “mystified.”

Is it possible I have
- Peripheral Aterial Disease?
- Micro vascular disease
- Nuerological problems?

Do you think these pains are agina related or something else?

- I can’t reproduce these pains by physical movements, that is what concerns me so much.

If you could give me your professional opinion on what you think I should ask my doctor to move in a particular direction to rid me of the pains I keep having, as they do scare the hell out of me. I have been pushing hard with him to find the cause, but so far, have come up empty handed. Thank you so much.

Thank you for the excellent well thought out response. O should be clear that at times of rest i will get the left arm pain too. I will talk to my doctor and suggest to him what youve told me. If you have any other ideas, please share, thanks so much.