Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your recent complaints and would like to explain that your clinical symptomatology represents clinical components specific for exertional cardiac angina (chest pain that appears when exerting but subsides while at rest), but also nonspecific elements (persistently constant chest pain).

So, coming to this point, it is necessary to perform a careful differential diagnosis investigating potential cardiac or extra-cardiac reasons.

As your ECG at rest has resulted normal, additional cardiac tests are recommended for exploring potential coronary artery disease:

- cardiac ultrasound (exploring cardiac structure and potential pericardial effusion),
- exercise cardiac stress test (in order to reproduce conditions for discriminating a potential stable cardiac angina).

Also, other additional tests for exploring alternative responsible factors of your chest pain could be helpful:

- chest X ray study,
- backbone imagine study (MRI or CT in case a degenerative backbone disorder is suspected),
- PCR & ESR (for ruling out/in inflammation in case of costochondritis, etc.)
- pulmonary function test
- arterial blood gas analysis
- pulmonary angio CT or ventilation/perfusion lung scan (in case pulmonary embolism is suspected)


If no extracardiac causes are detected and there exists still suspicion about coronary artery disease, then

- a coronary angio CT, or
- nuclear perfusional cardiac stress test, or
- dobutamine cardiac ECHO

would be recommended for further cardiac investigation.

You need to discuss with your attending cardiologist on the above mentioned issues.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

---