Brief Answer:
Life Style Changes / Further investigations / Follow up

Detailed Answer:
Hi friend
Welcome to Health Care Magic

PAIN
Negative TMT practically exclude Coronary Artery Disease. The pain has nothing to with heart. It is likely from the chest wall muscle - spasms…
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RATE
     Probably Sick Sinus Syndrome…. The fluctuation of rate is likely to be a disorder of the nerves (conduction system)of the heart – All other things are obviously normal
     Abnormal heartbeats need to be DOCUMENTED by ElectroCardioGram (EKG). Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly or is precipitated by a specific activity like exercise - one needs Holter or event monitor. Holter records for days; Event Monitor for weeks… Holter records continuously; Event Monitor only at certain times
If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced investigations – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. There are other advanced treatment modalities - like ablation (thermal or radio-frequency), which could be done during EPS. Though the test is the gold standard, it is INVASIVE and hence is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.
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CHOLESTEROL
HDL is good cholesterol – higher, the better.
LDL is bad cholesterol – lower, the better. In the absence of any other risk factor 100 is ideal for LDL-C. In the presence of other diseases (especially Diabetes and/or established heart disease), 70 should be the aim.
     Keep your weight to normal / even a little less
     Quit smoking, if you are a smoker
     Do regular EXERCISE – say walking or jogging - 30 minutes a day / at least 5 days in a week. Isometric exercise (like bull worker) is bad.
     Healthy FOOD is a must. Avoid saturated fats – coconut oil, palm oil, butter, ghee, full cream milk...Avoid junk foods in particular – French fries have palm oil / Pizza has cheese / XXXXXXX sweets are made in ghee.../ Change to Poly-un-saturated oil – like sun flower oil. / Include Mono-un-saturated oil – Olive oil.
Repeat the test in 2 to 3 months.
     Cholesterol can still be high, in spite of diet and exercise – you need drugs; because it is also manufactured in the liver – and that is determined by heredity. Statin is the first choice. In all probability, you will need a drug, since the level is high ans life style changes have a limited effet. Discuss your doctor – he will give appropriate prescription,,,
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Follow up with your cardiologist
Prognosis is excellent

Good luck
God bless you

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