chest pain with no diagnosis

[brokenhands]

hi, im 22 and i recently went to the hospital for the 2nd time for chest pain the first time i was dismissed after an ekg that showed nothing but the chest pain got worse and worse so i decided to get back and they did all there tests i had a couple ekgs, bloodwork and a chest x-ray and nothing showed up in any of it.  My pain is located on the left side and it doesn't move yesterday my arm was numb for a large portion of the day.  A lot of the time when it happens it comes and goes but sometimes it lasts hours, it feels like my heart gets tight really quickly then lets off and it can happen anytime so i havn't slept for more then 2 hours a day in a week.  If all the tests came back negative for any damage but i still have chest pain which is worsened by laying on my back what do i do?  Also.. im uninsured i was thinking i needed an echo to test for damage but the doc never brought it up just need to know where to go from here.  Thanks.

[kenkeith]

Unfortunately, there is cost management within a medical community that does not fairly represent an individual's health unless the diagnosis is obvious.  Sometimes an individual can be treated early with less cost rather than wait and have very high costs...that seems to be lost on the health care system.  Or there may be a belief that you are not having a life threatening event.  Sorry for your situation.  Hope your appointment with another doctor is helpful.

[brokenhands]

i know it should but as soon as they figure  out your uninsured they want you out the door as quickly as possible i guess if i want something done i'll have to black out in the waiting room

[kenkeith]

Experiencing chest pains should be enough to be given tests that rule out embolism (pulmonary clots) and thrombosis (vessel clots) that could cause the chest pain..  

[brokenhands]

i have another doc appointment in a couple days how do i make my doctor take this risk more seriously? How can i better my chances of being tested?

[kenkeith]

Physical examination may not be helpful for blood clots, and the diagnosis for embolus (blood clot) is made upon clinical suspicion based on history and risk factors. That condition should be ruled out...an EKG is not helpful and a clot in the vessels of the arm can cause the symptoms you have expressed.

The diagnosis may be made directly with imaging of the lungs or indirectly by finding a clot elsewhere in the body. The strategy used to make a diagnosis will depend upon each individual patient's situation, but there are some general tools available.

D-dimer is a blood test that can measure breakdown products of blood clots in the body but cannot differentiate a pulmonary embolus from a healing scar from surgery, or a bruise from falling. If this test is negative, then a pulmonary embolus can usually be excluded.

Lungs can be imaged with a ventilation-perfusion scan or a CT scan to look for a clot. Each test has its benefits and limitations, and use of these tests is dependent upon the clinical situation. If there are technical issues so that the lungs cannot be imaged, an ultrasound of the legs may be performed to look for a thrombus (clots); the concept is that if the symptoms are present of a pulmonary embolus and a clot is found in the leg, then the diagnosis can be inferred. Sometimes direct angiography of the pulmonary arteries may be performed.