<s>[INST] having many episodes of severe chest pains, nausea, clammy yet all tests come back normal. i have a pacemaker, utonomic failure and orthostatic hypotension.  my chest continues to give me severe pains...what could it be? also heart attacks with no damage, can they have all tests come back normal? [/INST] Hi thanks for asking question.Here at few possibilities in your case.1.You have put pacemaker.so first for chest pain heart condition has to be ruled out.you have not mentioned about which tests are done.ECG , echo cardiography and serum troponin estimation will be helpful to you for rule out cardiac condition.2.If heart problem not present then simple muscular pain might be the cause by heavy weight lift, exercise, excess coughing or bad sleep posture .simple analgesic will be helpful.3.If fever , cough like symptoms present redipratory causes ruled out like simple viral infection or pneumonitis like condition.chest x ray could be useful .4.The chest pain may be because of lastly referred pain if history of acid reflux present.I hope my suggestion will be helpful to you.Dr.parth </s>