55 year old white male, recent chest pain in sleep, and at work as an rn. stress test done and p wave flattend out during exercise?

CP: P wave flattening out during exercise, does not indicate ischemia. You may want to do a nuclear stress test or a cardiac cath after discussing with your cardiologist for a definitive answer. It especially indicated if you are a smoker have other risk factors.

Prinzmetals Angina: Sometimes the arteries to the heart can be susceptible to vasospasm. This typically causes resting chest pain, often at night. A stress test will probably be negative and even a routine catheterization will likely reveal no major blockages. The diagnosis can be confirmed by several means such as administration of medications to provoke spasm. Treatment is medical and different from typical angina.

Cardiac cath.: Stress tests have about 20% false negative. Passing stress test does not mean that you do not have coronary artery disease. Should have coronary angiogram best, or coronary cta and then angiogram depending of findings. Do not sleep on this.