If someone experiences chest pains for months, but has multiple ekg and blood work done with good vitals . what could be causing the chest pain?

For the sake of completeness, I recommend having a treadmill stress test. There are various causes of chest pains other than coronary blockages including coronary vasospasm,esophageal motility disorders,rib cage issues, pulmonary pathology. Usually with good history taking, a physician can get a good idea of the cause,order appropriate testing & advise the patient or refer you to a specialist.

Majority of hard to diagnose cases involve musculoskeletal pain. Having work up as outpatient should help as ER work up rules out usually life threatening conditions but does not fully diagnose such symptoms.

Causes can include reflux (treated with omeprazole/ famotidine) , gallbladder disease, musculoskeletal, anxiety, would also get x ray to check for chest lesions and echo to check heart structure/ function and for mitral valve prolapse/hypertrophy. There are rare cardiac conditions that can cause chest pain like bridging..