Differential Diagnosis for Center Chest Pain Worse When Lying Down
- Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is characterized by stomach acid flowing back into the esophagus, causing chest pain that worsens when lying down due to increased pressure on the stomach and relaxation of the lower esophageal sphincter.
- Other Likely Diagnoses
- Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause chest pain that may worsen when lying down, especially if the ulcer is located near the gastroesophageal junction.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp chest pain that may worsen when lying down and improve when sitting up and leaning forward.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain that worsens with movement or position changes, including lying down.
- Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although less likely if the pain is clearly related to position, it's crucial to consider ACS, including myocardial infarction, as it can present atypically, especially in women, diabetics, or the elderly.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of chest pain that may worsen with deep breathing or position changes, including lying down.
- Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that may radiate to the back and can be affected by position, although this is less common.
- Rare Diagnoses
- Esophageal Spasm: Abnormal muscle contractions of the esophagus can cause chest pain that may mimic cardiac pain and can be worsened by lying down.
- Nutcracker Esophagus: A condition characterized by powerful esophageal contractions that can cause chest pain, often related to eating or position.
- Mediastinitis: Inflammation of the tissues in the mediastinum, which can be caused by infection or other conditions, leading to chest pain that may worsen with position changes.