Chest Pain

I'm a 34‑year‑old male, moderate smoker. I have scary, angina‑like chest pain. My heart has been thoroughly checked and is perfectly healthy. I need help figuring out what's really going on.

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My symptoms:

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· Retrosternal squeezing/constrictive pain – feels exactly like a heart attack

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· Jaw pain (lower jaw, aching)

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· Teeth pain (diffuse, dentist found nothing)

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· Dull background aching pain after eating

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· No dysphagia (I swallow normally)

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· No heartburn, no regurgitation (no typical reflux symptoms)

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What triggers the pain:

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· Emotional stress → yes

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· Minimal exertion (walking fast, one flight of stairs) → yes

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· Eating → dull ache afterward

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· Heavy exercise (running, gym, peak stress test) → NO PAIN

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Cardiac workup – all normal:

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· 4 resting ECGs

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· Stress test: 12.4 METS, 117% of predicted max heart rate (185 bpm at 18% incline)

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· Echocardiogram

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· Troponin x3 – negative

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· Chest CT (standard) – normal

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My cardiologist says my heart is fine – even with smoking, the tests show no evidence of heart disease.

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Endoscopy (FOGD) findings:

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· Grade I hiatal hernia (Hill classification)

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· Very red (erythematous) lower esophagus, non‑ulcerated

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· Pangastritis

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· Biopsies were taken only from the stomach, not from the esophagus

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Biopsy results (gastric only):

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· Mild chronic non‑active, non‑atrophic antro‑fundic gastritis

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· H. pylori present (minimal quantity)

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· No metaplasia, no dysplasia, no cancer

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Treatment trial:

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· PPI (omeprazole/esomeprazole) for 1 month → no improvement in chest, jaw, or teeth pain

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My specific question:

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Can my esophagus really cause jaw and teeth pain? I always thought only a heart attack did that. Since my heart is fine (despite smoking), could an esophageal problem (like jackhammer esophagus, distal esophageal spasm, or eosinophilic esophagitis) send pain to my jaw and teeth?

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My other questions:

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1. Does my pain pattern (triggered by stress/minimal exertion/eating but NOT by heavy exercise) completely rule out a cardiac cause – even though I smoke?

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2. Can I have a motility disorder like jackhammer esophagus without dysphagia?

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3. Should I push my GI doctor for esophageal manometry and a repeat endoscopy with esophageal biopsies (to check for eosinophils or functional chest pain)

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4. If those are normal, is low‑dose amitriptyline reasonable to try for functional chest pain?

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The pain is real and scary, but all my heart tests say I'm fine. Thank you for any advice.