Chest Pain When Lying Flat, Down (On Stomach or Back)

The various causes of chest pain may be temporarily exacerbated by a change in position but chest pain that gets noticeably worse and persists or is triggered upon lying down may be due to specific causes. The presence of other signs or symptoms that either start up or aggravate when lying flat may help provide a more definitive diagnosis. Shortness of breath, sweating, dizziness or even fainting spells that may accompany the chest pain should be taken seriously and immediate medical attention is necessary.

It is important to verify whether lying flat, either on the stomach (prone) or back (supine), makes the pain worse or whether the exacerbation is transient and unrelated to position. Sitting up or even elevating the upper body should ease the pain either partially or completely. If this does occur then it can be substantiated that lying fdownis aggravating or triggering the pain.

It is important to note that one of the common times for a heart attack (myocardial infarction) is in the early hours of the morning. It is therefore important for high risk patients to be able to identify heart attack pain and differentiate between cardiac and non-cardiac chest pain.

Causes of Chest Pain When Lying Flat

Acid Reflux

The backward flow of acid up the esophagus produces a typical burning chest pain (heartburn), along with other symptoms like nausea, regurgitation and stomach bloating (a sensation of fullness). The pain may only start or aggravate upon lying flat and it is not uncommon for a person with chronic reflux (GERD) to awake at night from sleep due to heartburn. It is also important to note that acid reflux pain does not always present with the typical burning pain associated with heartburn.


Inflammation of the lining around the heart causes a sharp, stabbing pain although it may also be reported as an ache, rubbing or grating discomfort/pain. Pericardial pain tends to aggravate when lying flat and eases upon sitting up. Apart from the pain, patients also experience a shortness of breath when lying flat. Other signs or symptoms include a low grade fever, weakness and fatigue, dry cough and as the condition progresses, swelling of the abdomen or legs may be apparent.

Respiratory Chest Pain

Most respiratory causes of chest pain tends to aggravate when lying flat, especially on the stomach (prone), as breathing may be labored in order to inhale sufficient air. These causes are discussed under Lung Chest Pain.

Chest Wall Pain

The various causes of chest wall pain may aggravate when lying flat, especially when prone (lying on the stomach/chest). Other causes to consider include breastbone pain (sternum) and collarbone pain (clavicle).

Upper Abdominal Pain

The various causes of upper abdominal pain may cause referred pain in the chest. Pain below the breastbone (epigastrium) often falls into upper middle abdominal pain but many patients report it as chest pain. The most prominent causes in these cases, which often exacerbates when lying flat on the stomach (prone), is due to :

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