Hi,

Thanks for the query.

It would have been better if you had explained the nature and intensity of pain, please do not mind to answer these - Is the pain dull aching type/sharp/pricking type? Is there radiation of pain to the limbs, neck or back? Do you experience sweating, breathlessness, nausea, vomiting associated with the pain?

Ischemic changes in the heart cause chest pain which are usually severe in nature, radiating to limbs / neck / back, associated with sweating, breathlessness and other features. Such ischemic changes produced by block in the cardiac blood vessel. It is common to see such ischemic symptoms following stress, emotional disturbances and other physical strains. Clinically this condition is referred as ‘stable angina’.

Myocardial bridge may be associated with increased risks of ischemia. However since your last stress test was normal, I do not think it is a factor here.

Stable angina is one of the common conditions in a male above 40 years. They are usually associated with diabetes, high blood pressure, high cholesterol, being overweight, smoking, alcohol and other condition.

I suggest you to consult / discuss with your cardiologist. You may need a few tests such as ECG, repeat stress test, echocardiogram, lipid profile, blood sugar, blood pressure and other tests. Further modification in your medications is entailed to control and prevent cardiac complications in the future.

Hope I have answered your query. Should you have any additional concerns, I am available to address them.

Regards,

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Hi,

Since there is no pain on exercise it rules out stable angina. I am assuming it as muscular pain.
It is also good to know the blood lipid profile is normal. However recent blood sugar readings are a bit concerning. You can follow up with your doctor with a HbA1C test. If the blood sugar value is abnormal, consult a Diabetologist and a dietician can be helpful.

Now coming back to your primary concern - what could be the other causes of chest pain?
A few possibilities that I can think of are:
1. Muscular pain
2. Physical and emotional stress can cause increase in the heart rate as well as contraction. In a person having myocardial bridge, these forceful contractions can partly compromise blood circulation producing chest pain.
3. Oesophagitis can get worsened during emotional and stressful situations too which might lead to retrosternal discomfort.

My suggestions:
1. You can get a review of your medicine if a better option is available. Your treating cardiologist is the best person to do such modifications.
2. Continue use of proton pump inhibitors. Addition of antacid syrups for a week might prove helpful. This is the best way to know whether it is gut related or not.
3. Since you know the trigger factors that cause the pain, it is wise to avoid the situations by maintaining a dairy and making a note of such situations. Spend time each day for yourself for improving your overall health with Yoga, Breathing exercises.
4. Diet and life style modification such as regular diet, regular sleep, physical exercises, reduce caffeine consumption etc.

Hope my answer is both assuring and helpful.

Wish you good health.

Regards

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