Chest pain , like tightness an upper back pain an disoriented, extreme fatigue ...whats the cause ?

Concern for cardiac : Possibly an arrhythmia like afib. See your primary care md first. Cardiac cause needs to be excluded.

Consider heart: You are56. Any chest tightness should be considered heart until proven otherwise. Especially radiating to your back and associated with fatigue. See your doctor asap. Consider going to the emergency room if it recurs and does not go away within a few minutes.

Go to the ER ASAP.: It could be a dissecting aortic aneursym, heart attack, clot in the lung arteries etc. God bless u!