“pressure in chest and throat.”

Yes. chest pain should always be checked to rule out cardiac causes.

The symptoms you describe are somewhat atypical as they are predominantly at night. Thus my suspicion is that they are not cardiac in nature. However as some patients present in an atypical fashion I would see your PCP and possibly a cardiologist for further evaluation

Unfortunately, your symptoms could be an anginal equivalent , related to significant underlying coronary artery disease. Your age is just one risk factor (the others: hypertension, Diabetes, hyperlipidemia, smoking, personal history of CV disease, and a strong family history of CV disease in first degree relatives), but it appears you have been fairly healthy. The symptoms are atypical, occurring in supine position and less pronounced when performing ADL. Atherosclerotic (lipid rich) plaque in the coronary arteries will induce exertional anginal symptoms when the lesion occludes more than 70% of the arterial lumen. This degree of stenosis would also result in an abnormal perfusion defect during a nuclear stress test. However, I have had many patients over the years with multiple 95% stenosis in more than one coronary artery. Also, subtotaled 99% stenosis with delayed string-like flow. But not one of those patients had symptoms at rest. Classic angina is induced with exertion or stress/anxiety, and it is relieved with rest and/or sublingual nitroglycerin. You had symptoms at rest to a much greater degree than with exertion, the opposite of what would be expected from a significant coronary stenosis. The symptoms you described would be considered atypical ( not classic, but could represent her anginal equivalent). Atypical symptoms occur most often in the elderly population, with female gender, and in patients with autonomic neuropathy ( long standing diabetes). These patients experience exertional fatigue, lack of energy and dyspnea with exertion. Their is also a rare form of angina , called angina decubitus, which occurs in the supine position and not so much with activity. While the pattern of your symptoms wasnt classic, the qualities were worrisome for true angina. Heaviness, and pressure sound like someone with underlying CAD. The biggest clue was the fact that the discomfort radiated to both shoulders/upper arms. That is 95% specific for true angina from underlying high grade atherosclerotic plaque. You should be treated medically now ( asa, nitrates, beta block er, statin) and undergo urgent nuclear stress testing or invasive coronary angiography. Assuming the angiogram was done and came back negative, What else could induce such symptoms, in this pattern? The answer is gastrointestinal reflux, with esophageal spasm. The internal organs in the thorax (lungs, heart ) are innervated by the autonomic nervous system, via the 10th cranial nerve, the Vagus. Unlike skeletal muscle, the brain cannot distinguish between the esophagus and the heart. The heart sits on top of the esophagus and the hydrochloric acid in the stomach is .1% molar. Unlike the stomach, the esophagus doesnt have the protective mucous and goblet cells. When the acid refluxes and hits the esophagus, it will spasm. This pain can be quite severe and mimic true angina in every way , except one. The pattern. Both respond to nitroglycerin and both can feel like burning or pressure, with radiation. However reflux is exacerbated after a meal or lying down. The effect of gravity is lost in the supine position. And the brain, as mentioned, cannot tell the difference between these organs, referring the symptoms to what it does know, skeletal muscle ( arms). The patient would benefit from nitroglycerin, long acting. Bland diet and weight loss. Mostly, proton pump inhibitor therapy . Their are long term complications from chronic reflux (Barrett esophagus) but Short term the risk is low. In your case , I would treat both conditions and cycle the cardiac enzymes, ecg , echo. Stress test is an option but have a low threshold to perform angiography if the stress is even mildly abnormal. Coronary angiography/ coronary catheterization is a low risk procedure and takes less than 30 minutes. when done through radial access the complication rate is <1%. But its the gold standard for diagnosing and treatment of CAD. Also , intracardiac Pressures in the LV can be measured and LV function can be estimated. If the angiogram were negative, the patient will also get peace of mind. The pt can be referred to GI for EGD as an outpatient.