Chest Pain And Sleeping

[AngieP]

Hi there,

Occasionally I wake with chest discomfort/pain around 2am which is a little scary.

I find that the only way I can alleviate the pain sometimes is to prop myself up with pillows, so I'm sitting almost upright in bed. Then, the pain will usually subside and I can drift back to sleep.

Last night, I shifted back to lying flat and the pain returned once again. It does seem that the propped up sleeping position makes a difference.

I was wondering if anyone else has experienced this, and if they know the reason why having your head elevated helps?

I should also let you know that my cardiologist has assured me that there is nothing structurally wrong with my heart and that the chest pain is POTS related.

Thank you,

Angie

[gjensen]

Mostly, I get my worst chest pains in the transitions from sleep to wake, and wake to sleep.

Along the way (this is ever evolving and changing for me), I have had periods of time where I experienced what you describe. Just the act of laying down would trigger it. I would need to get down from being up too long, and upon laying down, need to sit back up. I would get some relief from the chest pain upon sitting up.

There are some adjustments that our vasculature makes resting, or exercising. Certain arteries constrict while we are at rest, and many vessels relax at rest. Opposite responses, and appropriate responses. During exercise they will do the opposite. One relax, while the other constricts. It is all about maintaining a balance of sorts. It seams that for some of us, some of the time, these hemodynamic fluctuations can be problematic.

I would say that our systems are challenged, and do not always respond appropriately. Some times over reacting, and under. I suspect that is what your experiencing, but it is my own theory, and I am no doctor.

These things are difficult to identify, and much of it becomes speculation.

I would discuss this further with your doctor, in detail, and ask if there is any ideas on how to manage it. If the pain goes away upon sitting up, it is not dangerous. You do want to be able to manage it, and for some of us, this is ever evolving.

Another thing that can cause chest pain laying down, and relief upon sitting up, is inflammation of the membrane around your heart. I do not believe that is what you are describing, but is something to be evaluated if the doctor suspects it. I am assuming this is a chronic problem, not acute, and you have been discussing this with a doctor.

Make sure that you discuss with your doctor, the possibilities that are not the typical structural problems with your heart and arteries.

[Dops]

My chest pain causes of coronary artery spasms and I usually take nitroglycerine to stop it. It works within 2 minutes But I have to lay down in 30 minutes after taking nitroglycerin otherwise I will faint. So that is why I cannot take it everytime.

[AngieP]

Hi gjensen,

Many thanks for sharing your thoughts and advice.

I will definitely discuss the pain again with my cardiologist when I see him in a few months.

Cheers,

Angie

[bigtrouble]

That is an odd one. I get chest pains during the day and it can last for a few hours. It might even be back the next day.

I think it is due to the heart pounding and some vibrations I feel. It causes irritation and chest pain.

What do you do about it?

[bethanyh]

I have constant left sided chest pain, it has been chronic for almost two years but within the past month it has started to slowly move to the right side as well. There is no rhyme or reason for the pain but it is excruciating and there every single moment of every day. I have seen two different cardiologists and neither one seems to think the pain is heart related though I do have "heart problems". No one has attempted further evaluation but this is my chief complaint to EVERY doctor that I go to, regardless of what they specialize in. The pain often radiates into my left arm, upper back (between shoulder blades) and neck.

bigtrouble: I have the same question, what do you do about it??

[bigtrouble]

bethanyh,

I figure that the pain is due to muscle tissue irritation, so I take 200 mg ibuprofen. I am not sure if it works.

I have also tried Vapor Rub. The burning sensation that the camphor causes helps mask the pain.

[SarahA33]

I know that most of you on this thread have active following cardiologist's, but if by chance you are experiencing chest pains that haven't been checked out and cleared by a doctor, it's safest to call your primary care doctor for further instructions.

[bethanyh]

bigtrouble: I cannot take ibuprofen type pain relievers but any time that I have tried Tylenol (extra strength) I take two pills, which equals 1000mg and I have no relief whatsoever. I have tried vapor rub, icy/hot, deep blue, and even had my doctor write a prescription for a compounding cream. Basically, you name it and I have tried it! Nothing relieves the pain.

Sarah: All of my doctors are saying it must be ANS related but not doing much of anything about it. Can't wait for CC, maybe they will have more insight!

[Dops]

did you try a vasodilatator? Or have you done an ECG while having chestpain?

[SarahA33]

Bethany - Your doing a really great job playing quarterback, so just keep hding on a few more weeks for help to arrive!

Sarah

[gjensen]

My main chest pains are coronary spasms, and nitro does relieve the pain. I have to be careful not to drop my BP too low when I take it.

I do get what I call POTS chest pain, but it is more of a general pain and pressure.

[bigtrouble]

gjensen,

It's good that nitroglycerine helps. How was it determined that it is coronary spasms? What method was used to measure it?

[bethanyh]

Dops: No, I have never been in a vasodialator and I have had several test performed while having the pain. Nothing seemed to show so the doctors that I have seen up to this point seem to think that it is nerve related. I have been told by one doctor that I have small fiber neuropathy, another disagrees so if I actually do have it, that may be a contributing factor.

Sarah: Your words are so kind, thank you! And thank you for the extra info that I should to take to CC with me, that is very helpful. I just wore a two week ZioPatch monitor back in May and my local cardiologist did not see anything that he deemed to be extremely concerning. He cannot figure out the pain aspect either so perhaps it is nerve related. I am hoping for a more thorough work-up and suggestions in a few weeks.

gjensen: I am curious about the coronary spasms, this is something I have not heard much about. What are they and how do you know when they are occurring? I am assuming they are fairly obvious when they happen.

[Emmyjewel]

I also have coronary spasms and or cmvd (coronary micro vascular dysfunction). Look them up- far easier to get the facts that way. U might find your symptoms fit the profile.

An indicator of whether it is likely to be one or both of these conditions (often they present together) is if the medication nitroglycerin works. If u r given nitro tablets, dissolve one under your tongue during symptoms, and your pain is relieved.. Very good indicator.

In saying that, nitro does relieve esophageal pain too.. But an upper endoscopy and barium swallow can rule out esophageal issues.

Getting coronary artery spasms or coronary microvascular disease diagnosed is a long and frustrating process.. It does not often present with normal cardiac testing. Please look them up.. Because if u have it it does need to be managed and not ignored.

[Debbie Rose]

I will get rapid heart rate with chest pain when I go to bed-lie down-if I have "snacked too heavily" before bed. And it took a while experimenting on amounts, types and time frame to figure out what works.

Remember our gastric system is very sensitive and nerves under the diaphragm go wonky- I don't know the mechanisms I just know what works

Also Reflux may not get up to the back of your throat but can trigger chest discomfort too, as can a hiatal hernia (one of my issues)

Just wanted to share my discoveries along the way

[gjensen]

I wish that mine was reflux etc.

[SarahA33]

gjenson, hoping that you are well. Always sending positive vibes out your way..

I just had a diagnosis of Prinzmetal's Angina brought up about a month ago. I don't have CAD and don't smoke. In my case, it was the addition of the Raynaud's diagnosis and pre-existing Chronic Migraine that actually raised eyebrow's of Prinzmetal's. I've been having chest pain for a while at rest only and cardiac testing is normal. There has been some discussion of adding Nitro but we haven't pulled the trigger yet.

http://www.ncbi.nlm.nih.gov/pubmed/15293589

http://www.cardiachealth.org/prinzmetal%E2%80%99s-angina

Something also interesting. I recently found out I was diagnosed with Raynaud's when I was 3.. still trying to figure out how this fits into everything.

[gjensen]

That is a change Sarah. If you or your doctors become convinced that CAS is a concern, nitro may become a real consideration. I use the tabs, and was cautious about taking them. I feel comfortable with taking them now, but I still have to be cautious. Before I take a second, I check my BP etc. I cannot just pop them as some others without autonomic dysfunction may be able to.

I do not remember if you are on a beta blocker or not, but that is worth considering. They are contraindicated with CAS.

I have always had a hard time gauging an appropriate response in public. I am concerned about causing unnecessary concern for some. Chest pain is a common and often benign symptom of POTS. On the other hand, I suspect CAS and MVA is more common in POTS than admitted. Both of these are difficult diagnoses on their own. Not to mention that they have received more attention recently, and many cardiologists are not quick to consider it. Before Mayo diagnosed me with them, I heard a lot of inconsistencies among different doctors on this topic. ERs often do not consider it, and many of the doctors and nurses are up to date. Of course there are many that are also. A simple question or two usually reveals those that are and are not.

Coronary arteries should constrict at rest. For some of us, they constrict too much. Should it be a surprise when we are already showing signs of adrenergic dysfunction?

That the chest pain comes at rest, is a reason to consider discussing this with a doctor. Particularly if there is pattern. Mine come as I relax to sleep in the evenings, and the transaction from sleep to wake.

[SarahA33]

I agree. I think there's a link for those of us with Coronary Vasospasms and Extra Adrenergic output for sure. Epinephrine is a constrictor. Maybe that's one of the reason's there is a higher link w/ pots patients and chest pain if cardiac testing is normal. I agree that a doctor needs to be on board!

I haven't experienced the angina in public yet, as it happens at night really. I do know what it's like to experience a migraine aura in public where I slur my words and walk into things because it is like someone chops my vision in half or it blacks totally. What I have a difficult time with is scaring those who are closest to me. A lot of guilty feelings for something I've got no control over.

Is MVA benign? Now that I'm on the Ivabradine I've got to be checked for long QT. Thanks for the heads up on BB's, which yes, I am on 240mg of propranolol. I don't know what I'd do without it, mainly for the adrenaline suppression, so the addition of nitro becomes even more complicated I suppose. Not sure if the episodes of CAS are often and painful enough to treat at this point. I'm glad for you that Nitro has been useful.