I have these intermittent chest pains

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Q:

I am a 43 yr old female. BP is 110/70. wgt125,hgt5’3″.Total cholesterol is 175.  Past month or so I have been having off and on chest discomfort. Sometimes it is an achiness and others like a burning between my breasts. Some days all day and other days nothing at all. I had a stress/echo in Oct. Echo was fine. Cardiologist ordered a nuclear CT scan with contrast because I had some of the symptoms while doing the stress test. Scan came back with a 0 calcium score and Dr. said my heart was perfect. I was having SOB at the time of those tests. Went back to my Dr 2 weeks ago and she did another EKG. She compared it to one from 2009 and they were exactly the same. She diagnosed me with an anxiety disorder. Now I seem to be having dizzy spells and “head rush” type feelings. I am so afraid there is something wrong with my heart. Can anxiety really cause so many symptoms? How accurate is a CT scan?

A:

Apart from the fact that you sound pretty healthy, I think you have had the appropriate work up for coronary artery disease (CAD) and all the tests have come back negative. Under those circumstances it is VERY unlikely a diagnosis of angina causing CAD was missed.
You can read more about this here:
http://www.cardiac-risk-assessment.com/heart-information/coronary-artery-disease
A cardiac CT scan for coronary calcium is a non-invasive way of obtaining information about the presence, location and extent of calcified plaque in your coronary arteries. Calcified plaque results when there is a build-up of fat and other substances under the inner layer of the artery. This material can calcify which signals the presence of atherosclerosis, a disease of the vessel wall, also called coronary artery disease (CAD). People with this disease have an increased risk for heart attacks. In addition, over time, progression of plaque build up (CAD) can narrow the arteries or even close off blood flow to the heart. The result may be chest pain, sometimes called “angina,” or a heart attack.
Because calcium is a marker of CAD, the amount of calcium detected on a cardiac CT scan is a helpful prognostic tool. The findings on cardiac CT are expressed as a calcium score. Another name for this test is coronary artery calcium scoring.
A negative cardiac CT scan for calcium scoring shows no calcification within the coronary arteries. This suggests that CAD is absent or so minimal it cannot be seen by this technique. The chance of having a heart attack over the next two to five years is very low under these circumstances.

The extent of CAD is graded according to your calcium score:

Calcium Score

Presence of CAD

0

No evidence of CAD

1-10

Minimal evidence of CAD

11-100

Mild evidence of CAD

101-400

Moderate evidence of CAD

Over 400

Extensive evidence of CAD

There are other reasons for chest pain you can find here:
http://www.cardiac-risk-assessment.com/ca-blog/chest-pain/
Finally, you can check your risk for heart disease here:
http://www.cardiac-risk-assessment.com/app/risk-assessment.php
Hope this helps. If you more questions, please come,
Dr T
http://www.cardiac-risk-assessment.com/

intermittent chest pains
Question: I am a 43 yr old female. BP is 110/70. wgt125,hgt5’3″.Total cholesterol is 175.  Past month or so I have been having off and on chest discomfort. Sometimes it is an achiness and others like a burning between my breasts. Some days all day and other days nothing at all. I had a stress/echo in Oct. Echo was fine. Cardiologist ordered a nuclear CT scan with contrast because I had some of the symptoms while doing the stress test. Scan came back with a 0 calcium score and Dr. said my heart was perfect. I was having SOB at the time of those tests. Went back to my Dr 2 weeks ago and she did another EKG. She compared it to one from 2009 and they were exactly the same. She diagnosed me with an anxiety disorder. Now I seem to be having dizzy spells and “head rush” type feelings. I am so afraid there is something wrong with my heart. Can anxiety really cause so many symptoms? How accurate is a CT scan?

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