I’m a 32-year-old male with a family history limited to a grandfather who passed away at a young age from an unidentified cause. For about two and a half years, I’ve been dealing with persistent, atypical left-sided chest pain that occurs around the clock. It’s a dull ache that fluctuates in intensity, usually between a 1 and 3 out of 10, though it can reach a 4 if I’m feeling particularly stressed or annoyed. Physical activity doesn’t seem to make it better or worse. I’ve visited the ER several times; my EKGs were consistently normal until this year when an incomplete right bundle branch block (IRBBB) was noted, but nothing else has changed. My cardiologist has been very thorough, performing an echocardiogram and a stress echo during the first year, both of which were clear. I also tried GI consultations and physical therapy, but neither helped. I’ve gone through several PPI trials and am currently still taking one. Earlier in 2025, I wore a Holter monitor, which also showed nothing unusual. During a recent follow-up, we discussed how the pain sometimes radiates to my back, but otherwise, it remains constant. My doctor suggested a coronary angiogram or MRA to rule things out, though they admitted they don’t strongly suspect a cardiac cause. I’m torn on whether the radiation and contrast are worth it, especially since this has been going on for so long. Does the ACA or any other medical guidance support this procedure in my case? Summary: CC is atypical upper left chest pain, occasionally radiating down or to the upper back. Tests so far: Holter monitor, stress echo (2 years ago), echo, troponin levels from the last ER visit, and numerous EKGs (IRBBB with a QRS of 104, but no major concerns).
In short: Probably not. You’ve already undergone an incredibly comprehensive evaluation, and a CTCA is unlikely to change the clinical picture unless it picks up some unrelated incidental findings. The symptoms you’re describing aren’t typical for a heart issue. In more detail: Having a normal stress echo at age 32 essentially rules out the possibility that your pain is caused by a major blockage in your coronary arteries. That specific test is meant to detect whether blood flow to the heart is restricted during peak physical exertion. If you hit a high workload and the results were clear, it’s a very strong indicator that you don’t have obstructive coronary disease and likely won’t for several years. Since your pain has been ongoing for years, isn’t clearly linked to exercise, and all your labs, heart rhythm checks, and imaging have come back normal, the chance of a coronary CT angiogram finding a relevant blockage is extremely low. While it might reveal some minor plaque or a rare structural variation, those things usually don’t cause chronic, low-level pain and probably wouldn’t change your treatment plan.