@stevetaylor721 I am surprised that a cardiologist would only do an EKG. It sounds to me like he did not take this seriously. Did you tell him about the intense upper back pain or is that new? Was there a reason they did not do imaging? If you don't feel like they are listening to you and being dismissive, you can get other opinions. You can also try Cleveland Clinic which is similar to Mayo. To get doctors to listen, you might start asking questions about aortic dissections and aneurysms and how they are diagnosed. Sometimes you have to direct the conversation. I am still suspicious of the Trazadone because your symptoms match the side effects. There can be more than one thing going on and maybe the drug is only part of it. You may want to ask if it interacts with the drug you take for gout. Was there a reason they put you on Trazadone and is this a doctor that you are still seeing? Did this drug seem to help? Are you drinking enough water? That can cause heart arrhythmias if you are dehydrated and affect blood pressure. My mom did that once and they put her in the hospital.

The other thing you may want to look at is a consult with a functional medicine doctor who looks at the biochemistry of the body. I have had doctors who were in AAEM, the American Academy of Environmental Medicine. They are not heart doctors, but may have insight into the gout or autoimmune issues because they look at processes that cause inflammation. Here is the website and there is a button in the top right for a provider search.
https://www.aaemonline.org/
How is your arm functioning now? Is there anything in moving it that may be causing the back pain or scapular pain? Has anyone tried to do a sleep study? Have you been seen by a neurologist? (they order sleep studies) You said that walking helps, are you doing that every day? Does it cause shortness of breath? Exercise can lower blood pressure. You have me baffled too. Do you need to keep taking the Trazadone? Do you know why it was prescribed?