You’re not alone in feeling confused and frustrated — many people with heart failure say the hardest part at first is not getting clear explanations.
Heart failure does not mean the heart has stopped. It means the heart isn’t pumping as efficiently as it should. An enlarged heart often develops because the heart has been working harder over time to compensate.
The symptoms you describe — chest pressure, heaviness, pain radiating to the neck/jaw/shoulders, and tingling or numbness in the left arm — are concerning and should always be taken seriously, even if initial ER tests were reassuring.

Regarding heart enzymes:

Troponin and other cardiac enzymes can be normal, mildly elevated, or fluctuate in people with heart failure without an active heart attack. Mild elevations can occur from:

✓Heart muscle strain
✓Enlarged heart
✓High blood pressure
✓Inflammation
✓Rapid heart rate
✓Heart failure itself
That may explain why the ER said things were “fine” (no acute heart attack), while your PCP later noted.

Common heart failure symptoms people report include:

✓Chest pressure or discomfort
✓Shortness of breath (especially with activity or lying flat)
✓Fatigue and weakness
✓Swelling in legs, ankles, or abdomen
✓Palpitations
✓Lightheadedness or tingling sensations

Treatment varies depending on the type and cause of heart failure but often includes:

ACE inhibitors, ARBs, or ARNI medications
✓Beta blockers
✓Diuretics (to remove excess fluid)
✓Mineralocorticoid receptor antagonists
✓Lifestyle changes (low sodium diet, fluid management, monitored activity)

At your age (38), it is especially important to identify the cause, which can include:

✓Viral myocarditis
✓Genetic cardiomyopathy
✓Uncontrolled high blood pressure
✓Valve disease
✓Prior infections or inflammation
✓Substance or medication effects
✓If you haven’t already, it’s reasonable to ask a cardiologist (if not already seeing one)
✓An echocardiogram (to assess pumping function and structure)
✓Clear explanation of ejection fraction
✓Clarification of whether your chest pain is ischemic, inflammatory, or pressure-related

You deserve clear answers. If something doesn’t make sense, keep asking until it does.

Your symptoms are real and important, even if ER tests didn’t show a heart attack.
Heart enzymes don’t only rise during heart attacks — heart failure itself can cause mild elevations.
ERs mainly rule out immediate life-threatening events, not long-term explanations.

Heart failure at 38 is uncommon but does happen, and many causes are treatable or manageable.
Feeling like doctors are giving you the “run around” is unfortunately common early on — cardiology follow-up is key.

Important:

*If chest pain becomes severe, crushing, or is associated with shortness of breath, sweating, nausea, or fainting — return to the ER immediately, even if you’ve been there before.*

Below are credible, authoritative sources with direct links that support some of the information given above.

Heart failure & enlarged heart
Mayo Clinic – Heart failure
https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Cleveland Clinic – Heart failure
https://my.clevelandclinic.org/health/diseases/17069-heart-failure
Enlarged heart (cardiomegaly)

Mayo Clinic – Enlarged heart
https://www.mayoclinic.org/diseases-conditions/enlarged-heart/symptoms-causes/syc-20355436
Cleveland Clinic – Cardiomegaly
https://my.clevelandclinic.org/health/diseases/21490-cardiomegaly
https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
Cleveland Clinic – Chest pain
https://my.clevelandclinic.org/health/symptoms/17643-chest-pain
Heart enzymes (troponin) and mild elevations
Cleveland Clinic – Troponin test
https://my.clevelandclinic.org/health/diagnostics/22770-troponin-test
https://www.acc.org/latest-in-cardiology/articles/2015/07/27/10/33/causes-of-non-acs-related-troponin-elevations
https://www.mayoclinic.org/tests-procedures/troponin-test/about/pac-20384815
https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/symptoms-of-heart-failure
Mayo Clinic – Heart failure symptoms
https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
There are additional references if needed.