Chest Pain When Lying Down

January 13, 2023

NOTE: If you are having new or severe chest pain, chest pain that doesn’t go away, pain that spreads down your arms, difficulty breathing, or changes to your heart rhythm, call for emergency help right away. Those can be symptoms of a heart attack.

Having chest pain for any reason is a cause for concern. There are a variety of serious health conditions that cause chest pain, and you should always talk to a doctor about new or worsening symptoms. Chest pain that gets worse when you lie down can be a sign of a condition called pericarditis.

What is pericarditis?

Pericarditis is inflammation of the pericardium, which is a sac that surrounds your heart. The pericardium has two layers of tissue with fluid between them. It protects the heart and holds it in place.¹

The pericardium can get infected and become inflamed, just like any other tissue in your body. A virus, bacteria, or fungus may cause the infection. You can also develop pericarditis due to a heart attack or after heart surgery.

Most of the time, pericarditis is temporary, and symptoms will go away after the underlying cause is treated. Pericarditis can recur, and in some cases, it can become chronic.

Symptoms of pericarditis

The main symptom of pericarditis is a sharp, stabbing pain in the chest, often on the left side. The pain usually comes on suddenly. You may also have pain in one or both shoulders. The pain usually eases if you sit up or lean forward. Lying down or taking a deep breath makes the pain worse.²

Other symptoms of pericarditis include:²

• Fever
• Weakness
• Coughing
• Trouble breathing
• Heart palpitations
• Fatigue

Chronic pericarditis can cause tiredness, shortness of breath, low blood pressure, and swelling in the belly, feet, and legs.²

How pericarditis is diagnosed

You will need to see a doctor to confirm that you have pericarditis. Your primary care doctor may be able to diagnose and treat you, but they might send you to a heart specialist. The doctor will ask you questions about your pain, when it started, other illnesses or injuries you’ve had recently, and what other symptoms you have.

Your doctor might be able to detect pericarditis by listening to the sound of your heart. When the pericardium is inflamed, it rubs against your heart and makes a noise called “pericardial rub.” A stethoscope can pick up the sound of pericardial rub.³

You may need additional testing, including:³

• Blood tests: Bloodwork can show evidence of a heart attack and test for bacteria or viruses that can cause pericarditis.
• Chest X-ray: A chest X-ray produces images of your heart and surrounding organs. Your doctor will be able to see inflammation or any fluid that’s collected around the heart.
• Electrocardiogram (EKG): An EKG detects abnormal heart rhythms. Electrodes on your chest record your heartbeat for the doctor to analyze.
• Echocardiography (PDF): This test uses sound waves to man images heart, showing any irregularities or fluid build-up in the pericardium.
• Computed tomography (CT): This specialized X-ray creates clear, detailed images of the heart and pericardium.
• Magnetic resonance imaging (MRI): A cardiac MRI uses magnets and radio waves to create images of your heart and pericardium.

Treatment of pericarditis

Treating pericarditis depends on what’s causing it. In some cases, the cause is a viral infection. There aren’t medications that can treat most viral infections, so your doctor may just advise you to rest until you feel better. Ask your doctor if you can take over-the-counter anti-inflammatory medications like ibuprofen or acetaminophen to manage your discomfort. If your pain is severe, your doctor may prescribe a pain medicine or a steroid to bring down the inflammation.³

Your doctor will give you an antibiotic if you have a bacterial infection causing pericarditis. Your doctor may want you to stay in the hospital for IV antibiotics and monitoring.³

If you develop too much fluid around your heart, you could have a complication called cardiac tamponade. This puts pressure on the heart itself and causes it to pump less blood. Without treatment, this can lead to low blood pressure and may be fatal. You will need surgery to remove the fluid.^2,3

Chronic pericarditis can lead to scar tissue and stiffening of the pericardium. If the tissue gets too tight, it can affect how well the heart works. You may need surgery called a pericardiectomy to remove the pericardium and allow the heart to beat normally.^2,3

Preventing pericarditis

There is no specific way to prevent pericarditis. Most cases of acute pericarditis are due to infection, and they get better once the infection goes away. However, if you have a history of pericarditis and suspect you’re having a recurrence, you should get prompt treatment to reduce the risk of complications or developing chronic pericarditis.

Other causes of chest pain

Pericarditis isn’t the only reason for chest pain, though it is the most common reason for chest pain while lying down. Other causes of chest pain include:⁴

• Angina: Lack of blood supply to the heart, often triggered by exertion.
• Respiratory infections: Illnesses like pneumonia or pleurisy can cause inflammation around the lungs and pain throughout the chest.
• Reflux: Gastro-esophageal reflux disease (GERD) causes acids from the stomach to creep up into the esophagus. It can cause heartburn, which is easy to mistake for chest pain.
• Pulmonary embolism: This is a serious condition where a blood clot prevents blood from getting from the heart to the lungs. It causes severe pain, breathlessness, and a cough. Seek immediate medical help if you think you may have a pulmonary embolism.
• Injury to the chest area: Bruising, broken ribs, and muscle strains in and around the chest can be very painful. If you have recently injured your chest area, talk to your doctor about treating the injury to avoid complications such as a punctured lung or pneumonia.

If you have new or worsening pain in your chest, do not hesitate to call for medical assistance. Speak with your doctor, visit an urgent care center or hospital emergency room, or call 911 for help. Prompt treatment may save your life.

References:

1. Mayo Clinic. Pericarditis. https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc-20352510
2. American Heart Association. Symptoms and Diagnosis of Pericarditis. https://www.heart.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis
3. American Heart Association. Prevention and Treatment of Pericarditis. https://www.heart.org/en/health-topics/pericarditis/prevention-and-treatment-of-pericarditis
4. National Health Service. Chest pain. https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/chest-pain