Wake at 3:30am with chest pain & palpitations- every day?

I was just wondering if anyone else does or ever has had an issue with waking up in the night at the same time each night, with chest pain and palpitations? Night…after night … after night….

I have always been a wonderful sleeper...go to sleep quickly and wake up around 6am with no alarm, feeling rested , alert and ready for the new day.

On 12 April was the first morning I woke at 5am with compressing chest pain and palpitations. This continued daily for 17 days. On the 30 April I awoke at 4am (same daily symptoms), this continued for 8 days. Since the 8 May I have been waking at 3:30am daily. So it’s been a month and I’m really getting annoyed with this.

(For those who do not know me…I was in hospital sept 2011 for chest pain. I had an ablation in 2000 for VT.)

I am being seen by a Gastroenterologist, who has pretty much decided my chest pains and spasms MUST be cardiac related. I have been seen by a cardiologist who thinks my symptoms are gastric related. I am seeing a new cardiologist on the 22 May. The classic “tennis game”, and I’m the ball!

This morning at 3:30am I used nitro (2 spays, and then 1 spray, but I don’t think I noticed a difference)., I was able to sleep from 5am until 7am.

I have had a recent pH Study which ruled out reflux. However, tonight I am going to prop myself up with pillows, just to make sure this is not why I am waking up?

I also have trouble getting to sleep, which is very odd for me. Sometimes I might toss and turn for 1-2 hours. Normally I could beat most sleep records and be asleep in as fast as 30 seconds.

Has anyone experienced anything like this?

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Yes, that sounds like Prinzmetal's angina.

From the American Heart Association:
Unlike typical angina – which is often triggered by exertion or emotional stress - Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.
Other names for this kind of angina include variant angina, Prinzmetal's variant angina and angina inversa. Pinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.
The pain is caused by a spasm in the heart’s arteries that provide the blood supply to the heart muscle (e.g., coronary arterie

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To finish my post: My Prinzmetal would wake me up 5 nights out of the week, and lasted about 45 minutes each time. It went on for months, misdiagnosed as a hiatal hernia and asthma. Quitting smoking was the only thing that eventually stopped it.

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My first SCAD heart attack was at 3:30 in the morning, and the second one was within 10 minutes of that time, 24 hours later. For the first few weeks after discharge from the hospital, I woke up a lot at that time of night, not with chest pains necessarily (although sometimes), but just waking up. I think it was more of a PTSD thing. I was so afraid I'd have another MI in the middle of the night. Eventually, as I got stronger and felt better, the pattern stopped.

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Sounds like classic Prinzmetal's Angina, from what I've read about it.

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I would still double check, do a trial w/CPAP. I suggest you discuss this with your cardiologist. My interventional now regularly refers her MVD patients to sleep medicine. It's worth a try.

Best, Mary

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Thank you everyone for your thoughts...
Mary ... I'm sorry I son't know what "CRAP" means... you may have told me in another post, but I cannot find it?

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Q1 Yes - I have coroanry artery spasm/prinzmetals/variant angina and I getpain ata around the same time every night.
Q2 CPAP = Continuous Pressure Air Pump. CPAP is used in the treatment of obstructive sleep apnea, which I along with many CAS and/or MVD women on this site have.

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I have had similar night experience with pounding heart - I thought it was early AM anxiety but after reading several of the above posts I am thinking it is probably Prinzmetal Angina (I will discuss this with my cardiologist in June). Surprisingly, I have already scheduled myself (after discussions with my doctor and getting her referral) for a sleep study towards the end of June. There is some question as to whether or not I have sleep apnea. I am not convinced I do but either want to rule it out or confirm that I do and go on from there (which would probably to see a CPAP). I can get TO sleep okay but have great difficulty staying asleep and being able to get back to sleep. I have night terrors and I do know have have anxiety (when all is quiet and I have time to think - it is hard for me to shut my brain off at night). I do not have a lot of the sleep apnea symptoms: dry mouth and/or headaches in the AM possibly combined with a sore throat. I do not fall asleep during the day. I do not wake up exhausted - but do get exhausted by the middle to end of the day (even though I am retired, I am very busy with the grandbabies, and life). But since my family has said (over the years and prior to my heart attack in Dec. 2011) that there have been times when I have appeared to stop breathing during sleep, I am going to have the study done (Oh, I do snore. It is disgusting but true. My mother was a snorer and I always have been.) Anyway, I am NOW more interested in finding out what is going on with me. I AM going to take better care of myself even if it means admitting that the I have sleep apnea.

Thanks all - these posts are so good. We can learn so much from one another.

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Sleep Apnea OR Hypopnea can meaning snoring, stopping breathing OR shallow breathing. I realize nobody wants to be identified as an unfeminine SNORER, but it can be much more than that.

When we have times when our brain lacks oxygen (as in the above), it gets to a point where it gets a shot of adrenaline and jolts us awake. Same thing could happen with night terrors. Either way, we are put into physiological fight or flight. Most of the time, we do not wake fully but shift positions, get some air and go back into sleep. When I had my study, I had NO stage III or IV sleep - restorative sleep and the sleep we need to keep us from being psychotic! Part of my problem was/is a deviated septum, so I only get 50% airflow in my right sinus, so the CPAP can correct for that kind of issue, too. Or Allergies that can keep you from getting proper air flow.

Also, lack of oxygen sets us up for a physiological cascade over time that can bring on heart disease and heart failure, plus a host of other problems. Sleep is CRITICAL! to our wellbeing. Those who already HAVE diminished oxygen supply (such as those with MVD),i it's even worse. We have two hands tied behind our backs. Please don't let vanity stand in the way of your health and survival.

All best, Mary
Also: CPAP means Continuous Positive Airway Pressure.

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Thanks Mary for the information. I definitely am NOT going to let vanity stand in my way. I had thought about having the study before but always let other things (people) come first. Since my heart attack, I am learning how to care for me regardless of the outcome. In other words, I am less afraid of the answers (good or bad) than I was before. Before, if I did not go to the doctor then I did not have to deal with any issues and if I did not have to deal with them then they did not exist - WRONG! I was just too afraid and at the time, I guess......I was going to say too vain but that is really not the case. I think it was more of just denial and a case of SUPERWOMANism. I have since learned that by NO means am I a superwoman. I am pretty incredible but I am cannot do it all for everyone.

There are not many parts of my body that are classified as small however I do have a small mouth (I am not able to open my mouth wide like a lot - my husband does not agree that I have a small mouth - lol), narrow airways (when I had ear tubes put in, Dec. 2010, my jaw had to be held back so hard because it was hard to mask me), and narrow nasal airways. I had not really thought about those being reasons for not sleeping well. You brought new insight - thank you.

So, yes, I am going to go for the sleep test (June 21) and if I am told I need to use a CPAP, then so be it. I sleep in an upright type position anyway so I do not think it would be too uncomfortable.

Thanks Mary - Melissa (PS - this is a totally random statement but my late mother's name is Mary Alice.)

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I agree, have a sleep study done.. People have learned amazing things from the results. Good luck!

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I just posted the below on another post, but thought I should copy it here...

To help me sleep at night, I'm trialling “tart cherry” concentrate (Tru2U made in NZ, http://www.tru2u.co.nz), which is natural melatonin. Last night was day three and I had a better night? Maybe it was the cherries? It seems expensive, but I am willing to try anything and it’s natural. Apparently during menopause our circadian rhythms get out of whack and this is supposed to help? I hope it works, not just because I desperately need sleep, but because it is soooo YUMMY, tastes like my great grandmothers cherry pie! Maybe it is the cuddly thoughts of my great grandmother that put me to sleep?

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I have and am experiencing that since September 2009. Never experienced anything like that before that time. I have always slept like a log, never had troubles in falling asleep, let alone in staying asleep. I have always been waking up naturally after 7 am. Right now I am sitting on my bed (it's 4.57 am, I woke up at 3.40). Sitting up AND being awake make my chest pain and palpitations disappear. It really feels like it is heart related, but it might also be of neurological origin. You might want to double check this with your neurologist. Nerves could get pinched between your thoracic vertebrae and cause trouble to your heart.

I also get left side pain. My cardiologist gave me nitroglycerin, which I have never taken. I see little point in taking it since once the pain awakes me at night I can stand up and usually wait for 10 minutes to see the pain fade away.

I had a sleep study done which didn't help much. So far nobody has been able to fix this, and it's almost 3 years now. I told my doctor about CPAP but he does not seem to listen to me. I also told him about my deviated septum, but he hasn't referred me to an ENT specialist yet.

How long did your VT last before the ablation? What was your heart rate on average during the day?

I hope melatonin worked for you!

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Just got back from sleep study. It was pure torture (won't go into details unless anyone is interested). Now I have to wait about 2-3 weeks to get results and to see if I need to go back.

I did not have most of the typical symptoms of sleep apnea: dry mouth, morning headache, extreme fatigue, falling asleep during the day, etc. But prior to the study I learned that sleep apnea can contribute to heart disease and that awakening during the night for no apparent reason is a symptom. Oh, I am (and always have been) a snorer. My husband has told me that he feels I have stopped breathing a few times during the night.

To make him (my husband) happy to take find out whether I do or do not I agreed to have the study done. My doctor referred me to a neurologist who then did an assessment. Based on all the information from both, obviously the study was warranted. I am anxious to find out the result.

I have been told I cannot take melatonin supplement because of the meds I am on. I do take a xanax which sometimes help with being able to sleep (I suffer from insomnia) but other times, I fight it. I am in the process of trying some other things to try to have a decent night sleep.

Take care all.

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I am glad you were brave enough and have survived the study. Please report your results to us when you get them.
Did the technicians give you any clue? I often ask the nurse or technician who is doing the test/study... sometimes they will not tell you a thing, but other times if you are super nice and chatty you can get some info from them. I know the best answere is waiting for the specialist report. But the waiting time after a test for results is torturous!

What medication are you on that have contraindications with melatonin?


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Hi rug,
So far I have not noticed the melatonin is working...but it did say take it for a month, so maybe ti takes awhile?
Unfortunately I cannot wait any longer, as it has been too long since I have had a good night sleep.
So last night I took a sleeping pill...I slept from 9:30pm and woke at 5am with chest pain and palpitations. So this is great! I was really not managing with the 2:30am and 3:30 am wake ups. I know I still had chest pain at 5am, but at this stage I need to be happy if I can tackle one thing at a time. Maybe one thing will help another?

My GP has asked me to do a 24 hour urine collection test for my adrenaline levels. This will show if my hormones are possibly causing my adrenal gland to kick it and being over stimulation these wee hours of the am.

We discussed the possibility of HRT if the urine test and hormone test indicate this may be helpful. She said after these tests comes in she will think about referring me to an endocrinologist for advice.

The problems is there are at least 3 main things (plus heaps of others) that can cause continual early am wake-ups:

1. Prinzmetals Angina
2. Gastro problems like Gallbladder
3. Peri-menopause and Menopause

Chicken before the egg?....Maybe someone can have all things going on? Maybe it is 1 or 2? Maybe one things triggered the others?

Re: Ventricular Tachycardia - I was having runs of VT for almost a year, my blackouts only occurred during the 10 days before my period. I do not recall my daily heart rate. They gave me a halter monitor at the wrong time to capture this. After I blacked out driving on a 100km road, they decided to implant a Reveal device (implanted in my chest like a pacemaker) with this they were able to have a recording of a blackout and recorded a run of VT's which indicated I was close to having a fatal MI. So they did an urgent ablation of my right ventricle outflow tract. And that was the end of my VT's!


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Hi Tamara,

I'm glad to hear the sleeping pill worked out ok. I tried so many you would not believe me and none worked so far, starting from herbal remedies (valerian, hawthorn), melatonin, to go to all sorts of benzo and non-benzodiazepines (alprazolam, lorazepam, diazepam, eszopiclone, zaleplon), mirtazapine, sertraline just to cite a few. Needless to say they only made the situation worse in the long run. This is just to say watch out.

I also had the 24h urine test, which was normal. I have been to an endocrinologist too but she didn't say much. One thing you might wish to do is to rule out the systems one at a time. An idea would be to start from the respiratory one, which might be easier to deal with. How do you sleep? I can only sleep prone or sometimes on my right side.

Regarding Prinzmetal the problem is that the only way to have it diagnosed is to have an acetylcholine echocardiography, which requires a heart cath. In any case, there is not much you can do about it apart from taking nitrates.

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Hi all - Another hard night. I tried a test and it was as I expected. When I had the sleep study done (of course the environment and conditions are not normal) I had to turn the TV off before going to sleep. It took me forever (during the study) to try to get to sleep. Last night I turned the TV off about 11 and at 1 am I was still awake. It was sometime later that I finally fell asleep (note: both nights had taken a xanax - which doctor had prescribed for me to help me with insomnia and some nights it helps while other nights I fight it).

I cannot remember right off which medications I am taking that react with melatonin (I will ask cardiologist when I see her in June - my list is getting longer almost each day).

The study was as I had expected ( my husband had warned me about all of the wires and wires being GLUED to my head/hair). The tech was nice enough but she came in a couple of times during the night, flicking on the overhead light to check/change wires. OMG was that really necessary? There was a CODE BLUE that scared the you know what out of me and sent me into anxiety (perhaps it is Prinzmetal Angina - yet another question to ask). I tried to get some info from tech but she was closed lipped.

In the AM I had a different tech and she appeared to be a bit of a ditz. She told me I would have to come back for another study (yet she could not tell me what, if anything, this was based on) and to call to schedule an appointment to discuss results with doctor. When I called the clinic, I was told the doctor would contact me (so just wait until then) in about 2-3 weeks. So, now I wait.

I love this waiting game. Will keep you informed. Have a wonderful Memorial Weekend.

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Sometimes I wonder if the pharmaceutical companies are in on this????

Just think ... if the doctors are convinced by the drug companies to create long periods of time between appointments, test and results...then they are able to create a patient who is also anxious and stressed, then may become dependent on more drugs for this. Plus if the doctors cannot find out what is wrong, they can just day it you are having a panic attack/anxious .... and the icing on the cake is you are a woman! So of course this is all happening, "woman and their hormones..., they just go through these little phases".
So I say let's NOT let this happen, let's not give them an excuse to dismiss what is going on in our bodies. (I am not saying anxiety is not real...of course it is, but someone needs to "HEAR US" and really make an effort to find out what is going on.)

Night 2 on my sleeping pill; I was so excited to have another good sleep....took the pill at 9pm, started to watch a movie, but by 9:30 I got sick of looking at Denzil Washington in double, so I went to bed. (the other actors were in duplicate as well)
1:30am .... wide awake, heart racing, chest pain BUMMER!!!!

Tonight I am not allowed one, so I will try again Monday night....


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Of course they are. Companies are always after money, including the pharmaceutical ones. Doctors know this very well, but in general I do not think that they want to make you anxious. Instead very often they try to solve the problem the easy way, prescribing sleeping pills or similar, which work on a global scale. If sleeping pills do not work within a week time, it would be wise to stop taking them.

Trouble is that issues with the heart can be very tricky to tackle at their root. Sometimes simple adjustments can make the difference.

Have you tried to sleep with more pillows or in a different bed? If you don't have one, I would suggest a sofa or even on the floor. Changing posture might have an effect on your sleep.

Also, is light disturbing you? Is the room too hot or too cold? Are there plants in your room? Is there fresh air coming in at night? Do you suffer from dry mouth at night? Do you use a humidifier?

Uh, I almost forgot. I woke up at 5 am with chest and left shoulder pain tonight. It was horrible as every single night/morning. Once I stand up things are much better, only the neck/shoulder pain persists.

And remember: Being anxious is not just a mind issue. There is often a biological/physical component in anxiety, especially when the heart has problems. Your heart communicates with your brain via the cardiac plexus and the vagus nerve. If something goes in your heart, your brain will become aware of the danger, which in turn will cause anxiety. Don't be fooled by doctors who tell you that you are an anxious person. Cardiac issues do cause fears and are connected to hormone imbalances as well. Unfortunately it is not always easy to tell which is causing which.

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