The first thing that clicks your mind while having an acute attack of chest pain is “heart attack”, but is it the only cause of acute chest pain? Indeed not, there are many trivial and less complicated causes of chest pain when waking up that may not require immediate or acute interventions. The severity of chest pain may vary from dull ache to burning or even sharp stabbing pain in character. Sometimes the pain seems to travel from heart to neck and then into the arms. There are multiple factors that may produce chest pain, including some serious ailments. So it is highly recommended to look for immediate medical assistance to find out the possible cause and best treatment options.

Possible Causes of Chest Pain When Waking Up

You must have heard people complaining “my chest hurts when I wake up” or even at rest. You may find it surprising, while doctors hear these complaints very often. However, not every episode is due to cardiovascular causes. We have listed here some possible causes of chest pain in the morning:

Gastric Reflux

Gastric reflux can include acid reflux or esophagitis. It happens when the food we eat is passed through the esophagus, but the sphincter that guards the communication between esophagus and stomach is not fully competent. In other words, it does not stop the acid from entering the esophagus, thereby leading to inflammation and esophageal irritation.

Symptoms: The most common symptom of gastric reflux is burning pain in the chest. This pain start from the upper part of stomach and goes all the way to the neck area. Other symptoms of acid reflux include feeling of sickness, sour taste in mouth like acid, discomfort in throat while drinking hot fluids, severe chest pain (that may also involve upper part of abdomen). Usually these symptoms do not tend to stay longer but may sometimes get worse after meals.



Costochondral joints serves to connect the ribs and cartilages together and the costo-clavicular joints connects the sternum (cartilage that links the ribs with breastbone) and clavicles (links sternum to collar bones). Costochondritis takes place when there is an ongoing inflammation in costochondral joints or costoclavicular joints.

Symptoms: In costochondritis, most patients report extreme pain in the chest that is intense and sharp and may get worse with movement. Individuals also report severe exertion while breathing. In most cases, the pain tends to affect a small area but can spread to broader parts of upper and lower chest. These symptoms may alleviate spontaneously after a few days. Painkillers or over-the-counter analgesics can be consumed for pain-relief.



Heart is the most important part of the body that requires effective circulation at all times in order to pump blood to the periphery. Angina pain is the result of ineffective or inadequate circulation of blood to the cardiac muscles due to narrowing of coronary arteries. This narrowing of arteries can be due to the atheroma formation at one or multiple locations within the coronary arteries. The pain usually arises from the heart when the cardiac muscles require more oxygenated blood than what is available to them.

Symptoms: Most statistically, significant symptoms of angina include pain and distress across the chest; especially when you are exercising or applying more force (such as physical exertion). Some other symptoms include nausea, tiredness, pain in arms, neck or stomach, fatigue, problems in breathing and sweating when exerting yourself. Usually the angina pain does not stay for a longer period of time and vanishes within few minutes after rest.


Heart Attack

Heart attack is inevitable when coronary arteries are blocked due to formation of a blood clot, thereby obstructing the blood supply to the heart muscles. The clot can be removed by medications to dissolve or dissolute the clot. Additionally, other sophisticated treatments are also available such as “angioplasty”. Heart attack can also take place due to ischemic damage to the heart muscles, hence also referred to as “myocardial infarction”. The pain of heart attack stays longer than angina pain and is more severe in intensity and severity.

Symptoms: The classic symptoms of heart attack include extreme pain in the chest even when you are resting or chest pain when waking up, feeling of extreme pressure and heaviness in the chest. Other symptoms include feeling of being dizzy, sick and fainting, profuse sweating and shortness of breath.


Stressed Muscle of Chest Wall

Our ribs are mostly surrounded with muscles that provide more flexibility to our ribs while breathing. Likewise, the chest feels pain when these muscles get strained and this can be due to over-stretching or ischemic injury of muscles. In some cases, the muscles may experience injury due to exposure to undue strain after lifting heavy weights, forceful and severe coughing for long periods of time and unexpected/sudden fast movements of chest.

The muscle can get inflamed, thereby increasing the pain while breathing movements. The pain may persist for a longer period of time and may even get worse with excessive activity.



The cause behind many cases of chest pain is anxiety, fear or tensed behavior, also referred to as “Da Costa’s Syndrome”. Sometimes the pain may get so extreme that individual misinterpret it as the pain of angina. The propensity of developing chest pain due to anxiety is much higher in individuals with a recent history of heart attack or other cardiac problems. In anxiety, there is no change in the health of coronary arteries but high levels of stress hormones may affect the normal physiology of coronary vessels.


Tietze Syndrome

Tietze syndrome takes place when the cartilage of one or more ribs get swollen or inflamed. The swelling is usually benign but can get very painful in some cases. It is usually hard to predict the course of pain; for example, it can be very sudden and generalized (i.e. spread to involve arms and shoulders); while in other cases, it may be trivial. As the pain is mostly benign, it can be managed without any treatment.



An injury in the chest region can also cause pain and discomfort. It can also be a result of viral infection or environmental factors. Other causes are:

  • ŸRibs’ problems: Injury in ribs including fracture can make the pain more dangerous with heaviness in breathing and coughing. The pain due to rib injury is mostly localized and aggravates on pressing. It also affects adjoining area of ribs with breastbone.

  • ŸStrain in muscle: When muscles stretch, the risk of strain increases. It can be due to heavy coughing or external pressure. Muscular strain can cause inflammation and chest pain that may persist for a longer period of time and gets worse with movement.


Other Causes

Few other causes of chest pain in the morning include:

  • Gas problem: In gastric situations, the diaphragm gets pressurized which further aggravates the stress on lungs and interferes with normal breathing. This can be treated by avoiding dairy products before sleeping and by quitting smoking and use of illicit drugs.

  • Problems in gallbladder and pancreas: Inflammation or damage to these tissues can also cause pain or discomfort in the abdomen and chest.

  • Sleeping positions: When you exclaim "Ouch! My chest hurts when I wake up," that could be due to your sleeping positions. Sleeping on one side of the body can increase pressure and stress on one side of the body that generates pain and feeling of stiffness.

When to Consult a Doctor

When you suddenly feel pain in your chest that doesn’t go with self-care steps or painkillers, then it is always suggested to see your doctor. You must seek medical help in following situations:

  • Pressurized feeling in chest near breastbone along with tightness and squeezing

  • Increase in the intensity of chest pain with the movement of left arm, back or jaw

  • Shortness of breath with chest pain even without any movement

  • Decreased heart beat rate and decreasing blood pressure

  • Feeling of vomiting, faintness, extreme sweating with frequent breathing and confusion

You must see your doctor in following situations:

  • Problems in swallowing food

  • High fever and coughing with yellow-green colored mucus

  • Extreme chest pain that lasts longer


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