? flase negative thallium scan

[asc01]

I'm a 61-year-old female, on treatment for hypertension and high cholesterol, 152 lb,  strong family history of ischaemic heart disease.  Chest pain last summer and autumn, when  BP was 200/110 and 180/106 respectively.  went away when my BP was controlled.  I have a heart murmur which they have never been able to identify, but an echocardiogram revealed slight left ventricular hypertrophy.  In April my thallium scan was negative.  I do have indigestion problems, but the pain is totally different in nature and location.

However, for the last two weeks I've been getting chest pain again:
central strong pressure
radiates to neck/jaw quite strongly
precipitated by exercise or intense concentration
usually goes off in 5 minutes
relieved by GTN

On Wednesday I had my most severe episode ever, triggered by hurrying for a bus.  It lasted over 20 minutes (the neck pain longer) and taking 3 doses of GTN to settle.  That was really scary.  I’ve certainly never experienced anything like that before, although I can’t define it.  Just occasional mini-episodes when I climb the stairs too fast now, but feeling totally shattered.

Medication:
Lisinopril 10mg
Diltiazem XL 120mg
Aspirin 75mg
GTN spray
Trazodone 150mg ) depression
Fluanxol 1mg )


I eat a healthy diet, am losing weight and have recently started at the gym.  My GP says this is OK ‘If I am sensible.’  On Tuesday I really overdid things, and after Wednesday’s scare, plus the fact that I feel so shattered, I’m having a break.

Am I being neurotic in thinking that my scan was a false negative and that I do have ischaemic heart disease. Could indigestion radiate into my neck and be relieved by GTN?   Could it be a non-ischaemic cardiac cause? My GP is going to refer me for an angiogram if it doesn't settle with diltiazem.  She feels it could well be cardiac in spite of the tests.  I wish I could have a monitor which could be activated to record an ECG when I have pain.

[asc01]

I have been on a variety of beta blockers in the past but had to stop because of adverse reactions:
    all produced severe fatigue and aching
    I react by dropping my BP excessively (especially in conjunction with lisinopril)
    in the past I had mild asthma when on propranolol

My BP currently varies between 112/72 and 148/95 - mainly around 125/80

[Cleveland Clinic]

You chest pain sounds cardiac in origin.  I agree with having an angiogram.  Instead of Diltiazem, I think you should be on a beta blocker.  Your blood pressure must be well controlled.  The monitor will not be helpful because it doesn't show ischemia very well.  NTG can relieve GI pain, but i think that in your case, it is cardiac.