39yo female with cad.. i suffer anxiety also.. heaviness in left shoulder/ arm.. heart attack has been ruled out ,i was in observation overnight

Difficult Question.: CAD is a very difficult problem and symptoms and signs can wax and wain. It depends on what the "Rule Out" Protocol is at your hospital ER. I would suggest that if any difference in symptoms that you have a recheck. Don't be afraid to go back. Sometimes it takes more than one visit to make a diagnosis. Diagnosis is a Dynamic and not just a Static process.

Next step?: Well' it's surely good that a heart attack was ruled out in the hospital, but has the extent of your pre-existent CAD been evaluated recently? Stress test? Catheterization? CT angiogram? Not having had a heart attack doesn't mean you didn't have angina, or a heart-related episode of pain. Your coincidence of CAD and anxiety makes subjective diagnoses of pain challenging.