Dear Sir Palpitations (which come and go) are usually prematre contractions and do not carry much significance when associated with a normal heart on ECHO. However we must demonstrate that palpitations are indeed premature contractions only by doing an ECG at that time or by holter monitoring. For chest pain, most important fact is if it is related to exertion/ running/ using stairs/ carrying weight or not. Further work -up will depend on the clinical judgement only. However for an anginal pain to be ruled out you have to have a stress test (if that is a possibility after clinical evaluation). One clinical condition which can be associated with both these at such a young age is mitral valve prolapse but that should have been picked on ECHO. Discuss with your doctor in light of above facts. Mean while avoid smoking, tea, coffee and alcohol as they all increase palpitations. sincerely