Differential Diagnosis
- Single most likely diagnosis
- Gastroesophageal Reflux Disease (GERD): The symptoms of a sinking feeling in the chest when laying down and extreme discomfort are classic for GERD, especially if the discomfort is exacerbated by laying down. This is because laying down can cause stomach acid to flow more easily into the esophagus, worsening symptoms.
- Other Likely diagnoses
- Anxiety or Panic Disorder: The feeling of the heart sinking can be associated with anxiety or panic attacks, which can cause significant discomfort and may worsen when laying down due to increased awareness of bodily sensations.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains or a feeling of discomfort in the chest that might feel like the heart is sinking, especially when changing positions.
- Sleep Apnea or Other Sleep Disorders: Although not directly related to the sensation of the heart sinking, sleep disorders can cause discomfort and anxiety when laying down, potentially exacerbating or contributing to the feeling described.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial Infarction (Heart Attack): Although the description does not classically fit a heart attack, any chest discomfort, especially when laying down, warrants consideration of cardiac causes due to the potential for severe outcomes if missed.
- Pulmonary Embolism: Sudden onset of chest discomfort that could be described as a sinking feeling, especially if accompanied by shortness of breath or worsening with position changes, should prompt consideration of a pulmonary embolism.
- Aortic Dissection: A tearing sensation in the chest that could be interpreted as a sinking feeling, particularly if it radiates to the back, is a medical emergency requiring immediate attention.
- Rare diagnoses
- Pericarditis: Inflammation of the sac surrounding the heart can cause chest pain that might be described as a sinking feeling, especially if it changes with position.
- Esophageal Spasm: Spasms of the esophagus can cause severe chest pain or discomfort that might feel like the heart is sinking, especially when laying down or eating.
- Hyperventilation Syndrome: Can cause chest discomfort or a feeling of the heart sinking due to rapid breathing, often associated with anxiety.