What Causes Sudden Onset Of Upper Chest Radiating To Left Arm And Jaw?

Question: i am a 54 year old female in good health, despite having controlled SLE with RA and Arachnoiditis, a result of a cervical epidural (I was having for pain control before my second cervical disc/fusion in late 2009) which appears to have "nicked" the spinal cord. There is no way to describe the horrific pain in the aftermath of the epidural and the disease has led to acute chronic pain, of which I have fairly well controlled with pain meds. Back in 2005 I had some mild chest pain and was told by a cardiologist that I have Microvascular Angina, a problem not uncommon with patients with SLE. However, after a few episodes of this rather mild chest discomfort, I have never had any more issues with it. In 2009, shortly before finding out I had a second ruptured cervical disc, I was at work (I am an RN) when I had acute chest pain with my BP being quite elevated, along with a rapid heart rate. I went directly to the ER at the hospital I was working at and though the EKG did not show any outright abnormalities, the cardiologist decided to do a heart XXXXXXX to be able to rule out any cardiac issues altogether. Fortunately, I was found to have all my arteries 100% clear and therefore, I left the cardiologist scratching his head wondering what was causing the issue. Well, the next day was when I had a MRI showing the second ruptured cervical disc and my neurosurgeon said that it was not too uncommon to have referred pain, imitating cardiac pain, to the chest and radiating to the jaw, as had happened to me. Once the surgery was over, I never had any episodes of chest pain. That is, until yesterday. Totally out of the blue and when I was not exerting myself at all, as I was sitting down looking at some family pictures, I had horrific chest pain that just about made me double over in tears as it radiated up my neck to my jaw and left shoulder. I did not have any SOB and the pain was only in the upper chest area with no pain in the epigastric or abdominal regions. Once I could stand up, I grabbed about four TUMS, as that is what my (now retired) cardiologist had told me to initially try doing to be able to differentiate cardiac pain from any type of gastrointestinal issues. The TUMS did not give me any relief. I found a bottle of old Nitroglycerin my cardiologist had given me in 2008 and despite knowing they were most likely no good, I took one and within about 10-15 mins, the pain started letting up. Overall, I would say the acute pain stayed with me 30-40 mins. To make a long story short, I ended up going to our local ER and in triaging me, they did an EKG that obviously did not throw up any flags, as I was sent back to the jammed packed waiting room to await being called back. Well, it was going to be hours until I was seen and since the pain had basically subsided, despite leaving me with a terrible headache across the frontal lobe and forehead, I signed out and went home, planning to follow up with my primary physician today. However, I have been trying to communicate since early this morning via email with my physician's head nurse (the one who had told me I must go to the ER yesterday when I called to see if I could come to the clinic re the chest pain) and have yet to get any response from her, indicating to me that my primary doc must not be too concerned with my issue. In my email, i asked about getting a referral to a cardiologist--in case I have another episode in the future--and have heard absolutely nothing and the clinic is closed for the day now. Sorry for so much detail, but I do have a rather complex history that I felt needed to be relayed with my question. I guess what I am consulting with this site about is (1) Do I need to be concerned at all about the chest pain episode though I have had no other pain/discomfort since yesterday--except for an ongoing dull headache? and (2) What are some possibilities that would cause such a one-time very sudden, non-exertional, episode of excruciating upper chest pain that radiated to my jaw--mainly left side, but somewhat generalized--and radiated to my left shoulder, all without any noticeable breathing issues and as far as I know, a normal EKG? Thank you in advance for any advice you can give me regarding this issue.

Thank you for your reply to my question(s), Being a RN, I am aware of all the cardiac enzymes, etc...that can go along with any cardiac event, particularly a MI. Yes, I understand the symptoms tend to lean toward angina, but no one seems to be concerned enough to have wanted to help me yesterday or today when I tried repeatedly to contact my primary physician. I do have a history of migraine headaches, but the headache I experienced soon after the acute bout of chest pain was not like my usual migraines and today I have just not felt well and had a dull frontal headache. My migraines are almost 100% right sided and I have medication specifically prescribed for my migraines. Yes, I was nauseous,, but the nausea seemed to be more part of the extensive chest pain at the time I was experiencing it. Anyway, thank you for your input. My plan is to call a cardiologist I want to use and make an appointment and THEN, call my primary doc to get a referral. I do not know what else to do. I usually do not get frightened when I experience problems with my health, but I have never been so frightened as I was for the 30-40 mins of acute pain I experienced yesterday

Yes, I am well aware that stress can play a large part in health issues in our lives. However, I was not under any abnormal stress before the chest pain hit totally with no warning. Yes, I feel sure the headache was more stress-related, as the chest pain frightened me and not knowing the cause, can contribute to further stress. I do want to point outr that I eat a very healthy diet, am not overweight at all, and exercise regularly, as I walk just about every day for 45 mins to an hour. I do it not only for physical health, but for my mental well-being as well. The problem I am encountering is getting my primary physician's office to return my call so I can follow up with my primary and have him give me a referral for a local cardiologist I know and feel I need to at least see for a baseline visit--just in case I have another event like I did on TUesday. You mentioned that you are glad I am taking medications as prescribed; however, as I mentioned earlier, I have yet to get with any doctor regarding the chest pain episode and thus, the only meds I take are for my lupus and for the pain associated with the Arachnoiditis. Thank you for your input and for giving me some insight as to what may be the problem. I also think I am going to follow up with my neurosurgeon regarding any more cervical issues, as I know I have another cervical disc bulging and maybe I am getting referred pain from it, as I have experienced before. However, in the past, the chest pain associated with referred pain from the second ruptured disc, was not so sudden and acute and the mild to moderate chest pain continued intermittently until I had the disc/fusion surgery on it.