More elaborated history needed regarding joint pain, 2D Echo report and ASLO TITRE AND
CRP for thematic fever and rheumatic fever first event at this age generally unusual but if got unnoticed in childhood and now may be second time that is only possibility. To consider this Heart attack biomarkers, ECG changes, 2DEcho and ultimately angiography will help. If these two are rulled out there nothing major can consider from cardiac point of view. Could be costocondritic pain, gastritis, pleuritic pain etc. Other things need to be ruled out