Being stirred from sleep with a sharp twinge in your chest can be scary. While many of us have woken up with heartburn after a spicy supper (more on this later), sometimes morning chest pain can be a sign of a serious health issue.
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Here, John Higgins, MD, a cardiologist with UTHealth Houston, explains why you might wake up with chest pain and what to do when it happens.
If you experience any type of chest pain, it's important to be thoroughly evaluated by a doctor. “When in doubt, get it checked out,” Dr. Higgins says. “If things don’t seem right, listen to your inner voice — you know yourself better than anyone."
1. You’re Having a Heart Attack
Morning chest pain can be a telltale sign of a heart attack. Also known as a myocardial infarction, a heart attack occurs when the heart muscle doesn't receive sufficient blood, according to the Centers for Disease Control and Prevention (CDC).
And the morning makes you most vulnerable. "The peak time for a heart attack is around 6:30 a.m.," Dr. Higgins says. That's because, at this time, "the circadian system sends out an increased amount of stress hormones, as well as a substance called plasminogen activator inhibitor, which thickens the blood," he explains.
That's a problem because plasminogen activator inhibitor stops dangerous blood clots (that can cause heart attacks) from breaking down.
In addition to chest pain, other common signs of a heart attack may include the following, per the CDC:
- Feeling weak, lightheaded or faint
- Pain or discomfort in the jaw, neck or back
- Pain or discomfort in one or both arms or shoulders
- Shortness of breath
Fix it: Don’t hesitate: “Call 911 and get to the ER,” Dr. Higgins says. The sooner you see a doctor, the better.
“Depending on the type of heart attack, we usually treat with IV medication as well as stenting (percutaneous coronary intervention) or clot busters (thrombolytics),” he says. “In addition, we will do an ultrasound of the heart to evaluate how much damage has been done,” he adds.
2. You Have Pericarditis
A sharp, stabbing chest pain, which usually comes on quickly, is a common byproduct of pericarditis, a condition characterized by the swelling and irritation of the pericardium (the thin, saclike membrane surrounding the heart), Dr. Higgins says.
Because lying down and breathing deeply worsens the chest pain associated with pericarditis, you're more likely to feel it while in bed, Dr. Higgins says. The discomfort often subsides upon sitting up or leaning forward, he adds.
Other symptoms of pericarditis may include, per the Mayo Clinic:
- Pain that spreads to the left shoulder and neck
- Fatigue or general feeling of weakness or being sick
- Leg swelling
- Low-grade fever
- Pounding or racing heartbeat
- Shortness of breath when lying down
- Swelling of the belly
Fix it: See your doctor ASAP. “Usually we treat [pericarditis] with aspirin/NSAIDS and colchicine [a drug that decreases inflammation in the body] for weeks to months,” Dr. Higgins says.
And steer clear of strenuous or high-intensity exercise while you recover, he adds. Instead, stick to low-intensity exercises like walking, bicycling and yoga.
3. It's Myocarditis
A heart condition called myocarditis may be the reason for your morning chest pain.
"Myocarditis means inflammation of the heart muscle," which is commonly caused by a viral infection (including COVID), Dr. Higgins says.
The following are common symptoms of the condition, he adds:
- Sharp or stabbing chest pain/pressure
- Shortness of breath
- Painful muscles/joints
- General fatigue and a feeling of not wanting to get out of bed in the morning
Fix it: Myocarditis requires medical treatment. “Because it’s caused by a virus (in most cases), we treat the symptoms with the hope that the infection abates and the body's immune system wins the battle over the viral infection,” Dr. Higgins says.
4. You Have Angina
"Angina is chest pain caused by insufficient blood and oxygen supply to the heart muscle resulting from coronary artery disease (narrowing of the heart arteries)," Dr. Higgins says.
So why might angina pain attack in the a.m.? "The pain is worse when you lie down because the extra blood from your legs flows back to the heart," creating more work for your ticker, Dr. Higgins says.
"Unfortunately, the narrowed coronary arteries don't allow the extra blood flow to supply the heart with the extra oxygen it needs, so this results in chest pain," he explains.
Plus, as we know, "in the morning, the circadian rhythm increases stress hormones that make the heart pump harder and worsen angina," Dr. Higgins adds.
In addition to chest pain, symptoms of angina may include, per the Mayo Clinic:
- Pain in the arms, neck, jaw, shoulder or back
- Shortness of breath
- Stomach pain, especially in people assigned female at birth (AFAB)
Fix it: See your physician as soon as possible. They can assess, diagnose and treat you accordingly.
5. It's a Chest Injury
An injury or strained muscle may be responsible for your morning chest pain.
"Musculoskeletal chest pain is usually sharp and localized," Dr. Higgins says. "And often the person can remember the event where they hurt themselves [like a sports game]," he adds.
Costochrondritis — when the cartilage that attaches the ribs to the breastbone becomes inflamed as a result a trauma (like a blow to the chest) or physical strain (think: heavy lifting or twisting) — is a prime example of musculoskeletal chest pain, Dr. Higgins says.
So, how can you differentiate between discomfort due to muscular issues and heart-related chest pain? A key feature of musculoskeletal pain is that it worsens when you press on the area or perform certain movements, Dr. Higgins says.
Fix it: While musculoskeletal chest pain isn’t usually serious, you should still get checked out by your doctor. “In general, we treat musculoskeletal pain with rest and pain relief,” Dr. Higgins says.
You may also see a physical therapist who can suggest exercises to help your healing process.
6. You've Got a Pulmonary Condition
Pulmonary problems (i.e., issues with your lungs) can cause you to wake up with chest pain too.
"Pulmonary embolism (a blood clot that lodges in the blood vessels of the lung) is the most common cause of pulmonary-related chest pain and usually starts as a sudden, intense, sharp, stabbing pain that grows worse with breathing in or out," Dr. Higgins says.
Other signs of a pulmonary embolism may include, per the Cleveland Clinic:
- Sudden shortness of breath
- Unexplained sharp pain in your arm, shoulder, neck or jaw
- Cough with or without bloody mucus
- Pale, clammy or bluish-colored skin
- Rapid heartbeat
- Excessive sweating
- Feeling anxious, lightheaded, faint or passing out
Other lung issues — such as severe pneumonia — can also cause pulmonary chest pain, Dr. Higgins adds.
Fix it: Lung-related chest pain can be potentially dangerous, so it’s important to consult with your doctor immediately. Indeed, pulmonary embolisms can inhibit blood flow and, in severe cases, result in death (more than 100,000 Americans die from this condition every year), according to the Cleveland Clinic.
Similarly, pneumonia, if left untreated, can cause serious complications, especially for people in high-risk groups such as individuals with weakened immune systems or pre-existing lung or heart disease as well as young children and seniors, per the Cleveland Clinic.
Most cases of pulmonary embolism are treated with blood-thinner drugs to help the clot dissolve, Dr. Higgins says, while pneumonia may be treated with antibiotics.
7. It's Heartburn
Heartburn could be to blame for your morning chest pain. A common symptom of acid reflux (which occurs when your stomach contents flow up into your esophagus, i.e., your swallowing tube), heartburn often feels like a flaming, burning sensation in the center of your chest, according to the Cleveland Clinic.
Heartburn often happens after eating spicy or fatty foods and worsens when you lie down, Dr. Higgins says. That's because this supine position makes it easier for acid and food to travel from the stomach back up to the esophagus, causing irritation, he explains.
In addition to chest discomfort, you may also wake up with the following, Dr. Higgins says:
- A sour taste in your mouth (from the acid)
- Trouble swallowing
Fix it: If you’re experiencing heartburn and acid reflux, consult with your doctor. Usually, remedies for heartburn and reflux include avoiding spicy and fatty fare that flares up symptoms along with eating well before bedtime (to give food enough time to move from the stomach down into the small/large intestine), Dr. Higgins says.
You can even try propping yourself up on two pillows to help reduce reflux at night, he adds.
Depending on the severity of your heartburn, your doctor may also prescribe certain medications to reduce the acid in your stomach.
8. You’re Having a Panic Attack
Sometimes your morning chest pain is motivated by something more mental than physical. Case in point: Panic attacks.
An acute episode of intense fear or anxiety, a panic attack often mimics a myocardial infarction.
During a panic attack, a person may experience chest pain (severe enough to cause difficulty breathing) and heart palpitations, Dr. Higgins says.
In addition to chest pain, a pounding heart and shortness of breath, other signs of a panic attack may involve the following, per the Mayo Clinic:
- Sense of impending doom or danger
- Fear of loss of control or death
- Trembling or shaking
- Tightness in your throat
- Hot flashes
- Abdominal cramping
- Dizziness, lightheadedness or faintness
- Numbness or tingling sensation
- Feeling of unreality or detachment
Fix it: First and foremost, always speak with your doctor, who can help rule out any underlying health issues.
If the cause of your chest pain doesn’t stem from a medical problem, consider talking with a mental health professional. Recurrent panic attacks may be an indication that you’re dealing with a condition like panic disorder.
Cognitive behavioral therapy — which helps you identify, address and cope with unhelpful thought patterns and behaviors — can be a very effective treatment for anxiety and panic attacks, Dr. Higgins says.
Additionally, practicing relaxation (through meditation and deep breathing) and exercising regularly can also help reduce stress and anxiety, he says.
- Centers for Disease Control and Prevention: “Heart Attack Symptoms, Risk, and Recovery”
- Mayo Clinic: “Pericarditis”
- Mayo Clinic: “Angina”
- Cleveland Clinic: “Blood Clots”
- Cleveland Clinic: “Pneumonia”
- Cleveland Clinic: “Pulmonary Embolism”
- Cleveland Clinic: “Heartburn”
- Mayo Clinic: “Panic attacks and panic disorder”