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Heart & Cardiology/Chest pain when lying down

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Question
I am a 31 year old woman. While my BMI classifies me as "obese", I have no other known risk factors for heart disease. For a long time, I have noticed that when I lay down at night my heart pounds very hard. I went brought a time for several months that it would cause me tonmotnbe able to hear for a minute because my heart was sounding so loud in my ears. I can feel my heart beating hard against my chest (and can see it beating) and tnte. It subsides. Recently it has started causing chest pain and pressure - whole it goes away for most part, I still have he pressure sensation to some degree the entire night. I have a pulse oximeter that someone gave me and it shows that mg o2 drops to 95 or so when I initially lay down and hen typically comes back up to 97-99. Not sure if that means anything. Recently it was severe enough that I went to the ER but everything was normal on their tests.

What could be causing these sensations?

Can a normal EKG, chest X-ray and labs rule out significant problems or should i find a physician to discuss this with?

Answer
Hello A,

Exercise, anxiety land occasionally heart trouble can make you heart beat loud and pound on your chest wall.  Obviously exercise do not contribute in your case, and anxiety doesn't seem very likely either.  Probably you should see a doctor and consider an echocardiogram to be sure your heart is normal.  Chest pain in a young person is usually cramping of muscles in the chest wall.  If pushing on the painful area modifies the pain (makes it better or worse), or if the pain is relieved by bending the body away from the painful area, that proves the pain is from chest  wall.  Even if these maneuvers donít affect the pain, itís still probably chest wall.  Pain caused by narrowing of the coronary arteries that supply blood to the heart is extremely rare below age 40. Chest wall pain is no threat to life or health, just a big nuisance.  Safest management is just to ignore the pain, though Tylenol, aspirin or ibuprofren usually help.

Please write back if this doesnít answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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