Question
I'm having chest pains, but all my tests related to the heart have come up clear. What could be the causing this pain?
Answer
Your question is at the heart of an important and common issue that cardiologists deal with regularly. When is chest pain a serious problem related to the heart? When is chest pain from something other than the heart? When is chest pain a minor annoyance that just requires reassurance?
Chest pain can be caused a blocked coronary artery, a heart valve problem, or a problem with the heart muscle, all potentially serious problems. Problems with the stomach, esophagus, lungs, chest wall muscles, cervical or thoracic nerves, or even gall bladder problems can mimic cardiac chest pain
Getting a good history as to the nature and quality of the discomfort, under what circumstances does it occur, and what risk factors the patient has, are the first steps to determining whether the pain is cardiac related. A good cardiac exam, along with basic tests like an electrocardiogram and an echocardiogram can give important added information.
There are various types of stress tests that can be done to evaluate whether the chest pain is from a blocked coronary artery, very common in our world, and potentially very serious. All these tests have a certain predictive value. In other words, they are not perfect. They are generally 90 percent accurate, but they can be wrong 10 percent of the time.
Anatomic evaluation of the coronary arteries, such as coronary angiography (placing a catheter through an artery to the heart, injecting contrast, and getting an x-ray motion picture of the coronary lumen) or a coronary CT angiogram are more accurate, but do carry a small risk from the contrast used, radiation used, and in the case of a coronary angiogram, risk of bleeding from the site or a blood clot forming on the tip of the catheter and causing a problem.
It is important to work with your doctors to rule out any serious problem causing your symptoms.