Chest Pain When Lying Down: What Might It Be?

Are you experiencing chest pain when lying down? Most of us equate chest pain with a heart attack, which could be life-threatening. Consult your doctor soon if you are experiencing chest pain. Chest pain could be due to cardiac or non-cardiac causes that can significantly impact the quality of life. In most cases, chest pain can be relieved with treatment.

Chest pain can be scary — in particular, left-sided chest pain that worsens when lying down at night. Patients describe chest pain using various words such as pain, pressure, tightness, or discomfort. Depending upon its underlying cause, such as cardiac infarction or a heart attack, chest pain can be life-threatening. Timely medical intervention becomes necessary.

Estimates suggest that each year, emergency rooms in the U.S. see 7.6 million cases of chest pain. Chest pain can be deceptive in nature, meaning patients with life-threatening causes of chest pain can show up in the emergency rooms without any major changes in their pulse rate or blood pressure. Doctors may need to observe the patient for a while and conduct several tests to uncover the underlying cause.

Five common causes of chest pain

As you or your loved one experiences chest pain while lying down, you may wonder — what might it be? Chest pain when lying down can be a symptom of some cardiac or non-cardiac diseases. Here we discuss five reasons for having chest pain when lying down.

Pericarditis

The pericardium is the outer covering of the heart that provides mechanical protection (avoiding friction with the rib cage or adjacent organs). Pericarditis is a condition where the pericardium gets inflamed. In acute pericarditis, chest pain often worsens when lying down. Sitting up or bending forward relieves the chest pain. Fever, pain in the shoulders, and palpitations are other associated symptoms.

Pericarditis can lead to serious complications such as cardiac tamponade (too much fluid around the heart), and chronic constrictive pericarditis (formation of scar tissue). But with timely medical intervention, most people recover from pericarditis.

Myocardial ischemia

When the blood vessels of the heart undergo a spasm, the blood supply to heart muscles gets obliterated, and this causes myocardial ischemia. Another cause of myocardial ischemia is a blockage in the blood vessels of the heart. In this disease, the pattern of chest pain is usually unpredictable. Emotional stress may increase chest pain. Also, a patient may wake up at night with chest pain. Typically, doctors recommend ECG to diagnose this type of chest pain. Chest pain due to ischemia is relieved by treatment with drugs such as calcium channel blockers and nitrates.

Unstable angina pectoris

Angina, or chest pain, is a symptom of coronary heart disease. Depending on its pattern, intensity, and cause, angina can be of various types e.g., stable, unstable, microvascular, and variant. Unstable angina pectoris shows a diverse pattern. In some newly diagnosed patients, chest pain occurs after exercise and nitroglycerin tablets provide relief. But in some patients, the chest pain comes during rest and nitroglycerin provides no relief. In such cases, doctors often advise hospitalization for diagnostic testing such as frequent ECGs whenever chest pain occurs.

Apart from cardiac causes, chest pain while lying down could be due to non-cardiac diseases.

Esophageal disease

Reflux esophagitis can cause chest pain that worsens with changes in the posture e.g., lying down or bending over at the waist. Typically, this pain happens after a meal such as a dinner and may also involve acid reflux, an acidic taste in the mouth. In this disease, the acid in the stomach damages the inner lining of the esophagus (food pipe). Your doctor may prescribe antacids or suggest specific postures or maneuvers to relieve the pain.

Other disorders of the esophagus such as esophageal motor disease and esophageal spasm can also cause chest pain. Diagnosing these diseases can be a challenge to a clinician sometimes, as the pain is relieved by drugs given for cardiac causes of chest pain. Follow your doctor’s advice for any lab work or ECG suggested.

Post-COVID condition (PCC)

Patients with severe COVID-19 symptoms sometimes continue to experience chest pain as long as 8 weeks after a hospital discharge. This chest pain could be due to diseases of the lung or pleura (e.g., pleuritis) or it could be due to the inflammation of any chest wall structures such as blood vessels, muscles, etc. Since these underlying causes of PCC chest pain may vary from patient to patient, continue medical care with specialists until symptoms are relieved.

Chest pain when lying down requires medical attention. Since chest pain can be due to a variety of reasons, doctors can help by making a differential diagnosis and developing a care plan. If left untreated, chest pain could turn fatal in some cases. However, most patients with chest pain can find relief from their symptoms after proper medical treatment. Talk to your doctor soon if you have experienced or are currently experiencing chest pain when lying down.