Heart pain then fainting

[blackbelt1]

My friend that is 19 years old has been suffering from chest pain (left side) for about a year. The pain covers his breastbone, and it sometimes sensitive to touch. He has episodes of pain that are sometimes burning, and others stabbing. When he gets the stabbing pain, he passes out. I witnessed this last night. I had put him on his back and elevated his feet. He had a very rapid strong heart beat when he was passed out, and when he came to, he started shaking, like a mini-seizure. He was passed out for 20 minutes, and he also shook for about 15 more minutes. I had held his head during the time that he was shaking.
He has gone to the doctor and has gotten CT scans, MRIs, and EKGs, all of which were normal. He also said his cholesterol and blood pressure are normal. His doctor has only prescribed a pain killer to take when he feels the stabbing pain coming on. These episodes are very frequent (at least once a day) and he has just begun passing out within the past month (in which he has passed out multiple times).
I know how unhealthy passing out is for your brain, but since his doctor cannot figure out what this is, could you possibly let me know of a few conditions or how to treat this?

[CCFHeartMD16]

This does not sound, based on your description, like it is related to the heart. Cardiac (heart) pain, is not reproducible with pressing over the area, and it is not typically a stabbing/sharp pain or burning, but rather a pressure sensation. Further, at age 19, it is unlikely to be heart artery (coronary) related unless he had a very severe family history. Things like arrhythmia (abnormal heart rate) can make people pass out, but are not associated with pain like you describe typically. Normal EKG is reassuring, but if more concern is present, especially due to his rapid heart rate (tachycardia), then a Holter monitor which will record his heart rate and rhythm for 24-48 hours can be useful.

Most important is that you describe that he was out for 20 minutes, followed by shaking for 15 minutes beyond that. Passing out from a heart cause usually means being passed out for a minute or two at most, not 20. Further, shaking afterward is not a feature of passing out from a heart cause. That is more concerning for a seizure! The pain may be a prodrome for a seizure (sometimes those with seizures have symptoms or sensations before the seizure begins, which can be a warning to get down and prepare for the seizure).

I would advise your friend to seek immediate medical attention, particularly from a neurologist. If they have specific cardiac tests they want to perform their evaluation, they can pursue them at that time.

[blackbelt1]

Thank you, you were a lot of help. I will have him go see one as soon as possible.