What is the diagnosis and treatment plan for a patient with chest pain and upper abdominal pain, given normal heart function test results?

Normal Cardiac Function with Chest and Upper Abdominal Pain: Evaluation and Management

Your echocardiogram results show completely normal heart function with no evidence of cardiac disease. Based on your normal cardiac test results, your chest and upper abdominal pain is most likely not caused by heart disease, and you should be evaluated for non-cardiac causes of your symptoms.1

Understanding Your Normal Echocardiogram Results

Your echocardiogram shows:

• Normal left ventricular function (63% ejection fraction) - This means your heart's main pumping chamber is working properly
• Normal diastolic function - Your heart is filling with blood normally between beats
• Normal right ventricular function - The chamber that pumps blood to your lungs is working well
• Normal aorta size - The main artery leaving your heart is normal
• Normal inferior vena cava with proper collapse - The main vein returning blood to your heart is functioning normally
• No pericardial effusion - No fluid around your heart
• Normal wall motion - All parts of your heart are moving properly, even during stress testing

What This Means For You

1. Your heart is structurally and functionally normal
2. Your symptoms are likely caused by a non-cardiac condition
3. The right bundle branch block (RBBB) on your EKG is likely an incidental finding that doesn't explain your symptoms

Next Steps in Evaluation

Since your heart function is normal, other causes for your symptoms should be investigated:

1. Gastrointestinal causes:

   • Gastroesophageal reflux disease (GERD)
   • Esophageal spasm
   • Gallbladder disease
   • Peptic ulcer disease

2. Musculoskeletal causes:

   • Costochondritis (inflammation of rib cartilage)
   • Slipping rib syndrome (may cause both chest and upper abdominal pain)2
   • Intercostal muscle strain

3. Pulmonary causes:

   • Pleurisy
   • Pulmonary embolism (can sometimes present with abdominal pain)3
   • Pneumonia

4. Psychological factors:

   • Anxiety or panic disorder (common cause of chest pain with normal cardiac testing)1

Management Recommendations

Based on your normal cardiac testing:

1. No cardiac-specific treatment is needed since your heart function is normal1, 4

2. Further evaluation should focus on non-cardiac causes:

   • Upper endoscopy if GI symptoms predominate
   • Chest/abdominal CT if pulmonary or other structural causes are suspected
   • Trial of acid-suppressing medication if GERD is suspected

3. Consider referral to gastroenterology for evaluation of upper abdominal pain

4. If symptoms persist with negative evaluations, cognitive behavioral therapy may be beneficial, as recommended by the American College of Cardiology for patients with recurrent chest pain and negative cardiac workups1

Important Considerations

• Your normal stress test results are reassuring and generally valid for approximately 1 year, assuming no change in symptoms4

• Even with normal cardiac testing, report any significant change in symptoms such as:

  • Severe, crushing chest pain
  • Pain radiating to jaw or arm
  • Shortness of breath
  • Dizziness or fainting

• The combination of chest and upper abdominal pain can sometimes represent referred pain from a single source, so a comprehensive evaluation is important5

• RBBB on your EKG is often an incidental finding in people with otherwise normal hearts and typically doesn't require specific treatment when cardiac function is normal

Your normal cardiac test results are very reassuring that your heart is not the cause of your symptoms, which allows your healthcare provider to focus on finding the true cause of your discomfort.