It sounds like your main concern is heart
disease, which was essentially ruled out two years ago with your thallium stress test
. (since your pain seems to have remained the same for at least two years, since it is intermittent in character, and since it isn't exertional in nature, it's unlikely that you have heart disease.) the only way to ensure that your coronary arteries are clear is through coronary angiography
-- or ct angiography -- which really doesn't sound like it's necessary.
When a patient has persistent pain
that defies diagnosis, it's always worthwhile to revisit the history: when does the pain occur? What makes it better or worse? What are the associated symptoms? Is the pain related to stress? Is it related to a specific activity, etc? In the case of chest pain, what are the patient's cardiac risk factors (e.g., cholesterol, hdl
, and triglyceride levels; smoking
; family history; diabetes; hypertension; obesity
; sedentary lifestyle, etc.)?
Physical examination also plays a key role in diagnosing chest pain: are the lung fields clear? Is there a murmur or valvular click (some individuals with mitral valve prolapse
experience recurrent chest pain)? Can the pain be provoked by chest wall compression, specific maneuvers, or changes in position? If a chest x-ray has been done, were there any unusual findings? Is the abdominal examination normal? (and so on)
if a thorough evaluation rules out any serious underlying conditions, we are often left with non-specific diagnoses, such as "chest wall pain
" or "muscular pain, " and the best we can do is reassure patients that 1) there doesn't seem to be anything serious going on, and 2) we'll be there to start the process anew should their symptoms change in any way.
Discuss your concerns with your doctor. Ask if there are any additional avenues that need to be pursued. Only you will know when you're comfortable that all such avenues have been exhausted.