I woke up with severe sudden chestpain, but they couldn’t find anything

Question
Info: Age- 18, Female, Had ASD repair when I was 8 years old, normal BP and HR, Good health no other medical conditions. The other night I was woke up out of my sleep with severe chest pains, they pain seemed deep and was worse while I was lying, bending forward, or breathing deeply. I have had a history of heartburn since a child so that was the first thought that came to mind was possibly heartburn, so I immediately took a Nexium 20mg. I sat in bed for over an hour hoping the pain would go away, when it didnt i decided to go to the ER. When I got there they ran several tests; chest x-ray, CT scan w/dye of chest, blood work, urine sample, EKG, and echo. Everything came back normal besides they said my White Blood Cell count was elevated to 23, which wouldnt be related to my chest pains.

They gave me morphine for pain which really didnt help, (pain stayed an 8-10 whole time in hospital) it more less just relaxed me. They finally released me about 7 hours later and the pain continued into that day and night as well, the next morning i woke up feeling better but still felt like a litle soreness. I have had more blood work done and my WBC is still elevated but infection has been ruled out, I belive where my feet swell that inflammation may be the cause. But I am worried about why i would be having these chest pains? I need answers and no one seems to be able to give me any! Any suggestions or possibilities of what this may be would help bunches. (Note: I see a cardiologist every 6 months, and family doc) Last month I also wore a Holter monitor for a month and had my cardio checkup, EKG etc. and everything was normal on that! I ran across something called Hiatal hernia. Does this maybe sound like this or would it be something to mention to my doctor about possibly testing for this? Sorry this is so long just wanted to include all information! THANKS MUCH

Answer
Sorry to say, but nothing much comes to mind (see below). You had just about all the tests I would have ordered and with them being negative, pretty much most possibilities have been excluded. I am concerned however about your elevated white count, because that doesn’t happen in a vacuum.

Take a look here, for more information about your heart:

http://www.cardiac-risk-assessment.com/heart-information/coronary-artery-disease-angina

http://www.cardiac-risk-assessment.com/heart-disease-diagnosis

http://www.cardiac-risk-assessment.com/heart-disease-treatment

http://www.cardiac-risk-assessment.com/cardiac-risk-assessment

The tests showed your heart is not the problem, so let me explain some other and more remote possibilities:

A Hiatal Hernia comes in two flavors: a “sliding” HH, and a Para- Esophageal HH. Sliders are relatively common, but most don’t cause symptoms. If they do it is because of stomach acid backing up into the esophagus, which isn’t built to tolerate that, and you get an acid burn that over time may progress to a stricture with difficulty swallowing. Your symptoms don’t sound like that all.

1. Normal Esophagus
2. “Sliding” Hiatal Hernia
3. Para-Esophageal Hiatal Hernia

The para-e variety would have shown up on the CT scan and chest X-ray. Here, a portion of the stomach gets stuck above the diaphragm. If that opening is too narrow you may have pain and it could be a surgical emergency. I don’t think you have that either.
Other possibilities include problems with peristalsis of your esophagus, and spasm is one of them (can be quite painful, often confused with a heart attack initially). It may be worth looking into this last option.

Esophageal spasms are abnormal contractions of the muscles in the esophagus (the tube that carries food from the mouth to the stomach). These spasms do not move food effectively to the stomach.

Symptoms

1. Difficulty swallowing or pain with swallowing
2. Heartburn
3. Pain in the chest or upper abdomen

Treatment

Nitroglycerin given under the tongue (sublingual) may be effective in an acute episode. Long-acting nitroglycerin and calcium channel blockers are also used to treat esophageal spasms. Rarely, severe cases need surgery. The cause of esophageal spasm is unknown. Very hot or very cold foods may trigger an episode in some people. It can be hard to tell a spasm from angina or  the symptoms of a heart attack. The pain may spread to the neck, jaw, arms, or back.

It is difficult to imagine however, that you would not have had symptoms in the past if that were the case.

Lastly, any person with sudden chest pain needs to be evaluated for a pulmonary embolism – a blood clot to the lungs. Besides pain, there is usually also trouble breathing and of course there has to be a source somewhere of that blood clot. Your tests would have shown if that were the case.

I am a cardio thoracic surgeon and dealt with all these problems a lot before I retired. These issues and your white count are what I’d look into.
Last, during my clinical practice if I didn’t know what was going on (it happened!), the first thing to do was to make sure the patient was safe, the second, to repeat tests to look for changes after a period of time, the third, ask for help.
Hope this was helpful,
Dr T
http://www.cardiac-risk-assessment.com/