palpitations that worsens lying down

Overview

Palpitations is the feeling that your heart is fluttering, pounding, skipping a beat, or beating too fast. When this feeling gets worse when you lie down, it means the sensation is more noticeable in that position. This can happen for many reasons, including changes in blood flow or pressure when you lie flat.

Yes, many people experience palpitations at some point. It is especially common for them to notice the feeling when they are trying to rest or sleep.

Palpitations can affect people of any age, but they are more common in those with anxiety, stress, or certain heart conditions. People who are very sensitive to their heartbeat may also notice it more when lying down.

Symptoms

Common symptoms

• Fluttering or pounding feeling in your chest
• Heartbeat that feels like it is skipping a beat
• A racing or thumping sensation that starts or worsens when you lie flat
• Awareness of your heartbeat in your neck or throat

Symptoms in children

• Children may describe their heart feeling like ‘a fish flopping’ or ‘butterflies’ in the chest.
• They might complain of feeling dizzy or lightheaded when lying down.
• Some children may become unusually tired or restless, especially at bedtime.

Symptoms in older adults

• Palpitations might feel less intense but may be accompanied by shortness of breath or chest discomfort.
• Older adults may feel faint or dizzy when lying down, which could indicate a drop in blood pressure or rhythm issue.
• They might also notice swelling in their legs or ankles if the cause involves the heart.

Causes

Main causes

• Anxiety, stress, or panic attacks – these can make your heart beat faster and feel stronger when you lie down.
• Heart rhythm problems (arrhythmias) such as atrial fibrillation, where the heart beats irregularly.
• Changes in blood pressure or blood flow when you change position (postural or orthostatic changes).
• Stimulants like caffeine, alcohol, nicotine, or some cold and allergy medicines.
• Hormonal changes, such as during pregnancy, menopause, or with thyroid problems.
• Low levels of potassium, magnesium, or iron in your blood.

Risk factors

• High levels of stress or anxiety
• Excessive caffeine or alcohol intake
• Smoking or using nicotine products
• Being overweight or obese
• Having a history of heart disease or high blood pressure
• Taking certain medications (always check with your doctor or pharmacist)

When to see a doctor

See a doctor urgently if:

• If you faint, feel like you might faint, or have chest pain with the palpitations.
• If you have a known heart condition and the palpitations get worse or change.
• If you are short of breath, especially when lying down.

Book a routine appointment if:

• If palpitations happen often or bother you, even if they are not painful.
• If you have a family history of heart problems or sudden death.
• If you are starting a new medication and notice palpitations.

Diagnosis

Your doctor will ask about your symptoms, when they happen, and your medical history. They will listen to your heart and check your pulse. Depending on what they find, they may order tests to look at your heart’s rhythm and structure.

Tests that may be done

• Electrocardiogram (ECG or EKG) – a quick, painless test that records your heart’s electrical activity.
• Holter monitor – a portable device you wear for 24 to 48 hours to record your heartbeat continuously.
• Event recorder – a device you wear for a few weeks; you press a button when you feel palpitations to record that moment.
• Echocardiogram – an ultrasound of your heart to see its structure and how well it pumps.
• Blood tests – to check for thyroid problems, anaemia, or electrolyte imbalances.

What to expect at your appointment

Most tests are simple and painless. You might need to wear a monitor at home for a day or two. The results will help your doctor decide if there is a problem and what kind of treatment, if any, is needed.

Treatment

Treatment depends on what is causing the palpitations. For many people, no treatment is needed. If a cause is found, the focus is on managing that condition and reducing triggers.

Self-care at home

• Avoid or limit caffeine, alcohol, and nicotine.
• Practice relaxation techniques like deep breathing or meditation to manage stress.
• Make sure you get enough sleep and stay hydrated.
• Keep a diary of when palpitations occur and what you were doing – this can help you and your doctor identify triggers.

Medical treatments

If palpitations are caused by a heart rhythm problem, your doctor may recommend medicines to help control the heart rate or rhythm. They may also suggest procedures like cardioversion (a controlled electric shock to reset your heart rhythm) or catheter ablation (a procedure to correct abnormal electrical signals). Always follow your doctor’s advice – do not stop or start any medicine without talking to them first.

When is surgery considered?

Surgery is rarely needed for palpitations alone. In some cases, people with certain heart rhythm disorders may need a pacemaker or implantable device, but this is decided by a heart specialist.

Living with this condition

For most people, occasional palpitations do not affect daily life. If they bother you, learning to recognize and avoid triggers can help. Keep a calm attitude – worrying about palpitations can actually make them worse.

Lifestyle tips

• Manage stress with exercise, hobbies, or talking to a counsellor.
• Limit caffeine, alcohol, and nicotine.
• Get regular physical activity as approved by your doctor.
• Stay hydrated and eat a balanced diet.

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins is good for overall heart health. Regular exercise like walking, swimming, or cycling can improve heart function and reduce stress – but start slowly if you are not used to it. Ask your doctor what level of activity is safe for you.

Mental health and emotional wellbeing

Palpitations can cause anxiety, and anxiety can cause palpitations – it can become a cycle. If you feel anxious about your heart, it may help to talk to a therapist or counsellor. Learning relaxation techniques can also break the cycle.

Prevention

Not all palpitations can be prevented, but you can reduce your risk by avoiding triggers like excessive caffeine, alcohol, and stress. Staying active, eating a balanced diet, and managing underlying conditions like high blood pressure or thyroid problems can also help.

Screening programmes

There is no routine screening for palpitations. If you have a family history of heart rhythm problems or other risk factors, your doctor may recommend occasional check-ups.

Complications

If left untreated

• If caused by an arrhythmia, untreated palpitations may lead to a faster or more irregular heartbeat that can reduce blood flow to the brain and body.
• This could increase the risk of blood clots, stroke, or heart failure over time.

Long-term outlook

For most people, palpitations – even those that get worse when lying down – are not dangerous and often improve with lifestyle changes or treatment of the underlying cause. With proper care, the outlook is very good. Even if a heart rhythm problem is found, modern treatments are highly effective.

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