Differential Diagnosis for Chest Discomfort when Lying Down
Single most likely diagnosis:
- Gastroesophageal Reflux Disease (GERD): This condition is characterized by stomach acid flowing back into the esophagus, causing discomfort and a sensation of the heart "sinking" when lying down, due to increased pressure on the stomach.
Other Likely diagnoses:
- Anxiety or Panic Disorder: These conditions can cause chest discomfort, palpitations, and a feeling of impending doom, which may worsen when lying down due to increased awareness of bodily sensations.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that may feel like the heart is sinking, especially when lying down or moving.
- Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain that may improve when sitting up and leaning forward, but can feel like the heart is sinking when lying down.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Myocardial Infarction (Heart Attack): Although less likely, a heart attack can cause a feeling of heaviness or pressure in the chest that may worsen when lying down, and is a medical emergency.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden, severe chest pain that may worsen when lying down, and is a life-threatening condition.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that may radiate to the back, and is a medical emergency.
Rare diagnoses:
- Mitral Valve Prolapse: A condition where the mitral valve does not close properly, causing chest discomfort, palpitations, and a feeling of the heart sinking, especially when lying down.
- Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, causing chest pain, shortness of breath, and a feeling of the heart sinking, especially when lying down.
- Eosinophilic Esophagitis: A condition where the esophagus becomes inflamed due to an allergic reaction, causing chest pain, difficulty swallowing, and a feeling of the heart sinking when lying down.