Can laying on my left side exacerbate palpitations?

Can You Feel More Palpitations When Laying on Your Left Side?

Yes, it is well-recognized that positional changes, including lying on the left side, can make palpitations more noticeable, though this is typically a benign phenomenon related to increased awareness rather than a dangerous cardiac condition.

Why This Happens

• Positional chest pain and symptoms are usually nonischemic (such as musculoskeletal or related to body position rather than heart disease) 1
• When lying on the left side, the heart is positioned closer to the chest wall, which can make normal heartbeats more perceptible and create heightened awareness of cardiac activity 2
• This increased awareness does not indicate that the heart is actually beating abnormally—you're simply more conscious of normal cardiac function in this position 3

Clinical Significance

The key distinction is whether these are simply more noticeable palpitations versus new or worsening symptoms:

• Palpitations that are purely positional (occurring only or predominantly when lying on the left side) and not associated with other concerning features are generally benign 1
• However, palpitations accompanied by dizziness, near-syncope, syncope, chest pain, or excessive fatigue require immediate medical evaluation 1, 4
• Sharp chest pain that increases with lying supine (flat on back) is more characteristic of conditions like acute pericarditis rather than ischemic heart disease 1

When to Seek Medical Attention

You should obtain a medical evaluation if palpitations are associated with:

• Dizziness, lightheadedness, or feeling faint 1
• Chest pain or pressure 1
• Shortness of breath or difficulty breathing 1
• Syncope (loss of consciousness) or near-syncope 1
• Palpitations that occur with exertion or emotional stress (which may suggest cardiac ischemia) 1
• A family history of sudden cardiac death or known structural heart disease 5

Diagnostic Approach If Evaluation Is Needed

If your palpitations warrant medical assessment, the initial workup should include:

• A focused history documenting the exact characteristics: frequency, duration, triggers, associated symptoms, and whether they correlate with position 1
• Physical examination including vital signs and cardiac auscultation 3
• A 12-lead ECG is essential as the gold standard initial test—a completely normal ECG makes heart failure or significant cardiac dysfunction unlikely 1, 4
• If palpitations are infrequent and unpredictable, a two-week continuous event monitor is more appropriate than a 24-48 hour Holter monitor 5

Common Pitfall to Avoid

• Do not assume that positional palpitations are always benign without first ruling out structural heart disease, especially if you have cardiovascular risk factors, are over 75 years old, or have other concerning symptoms 1
• Palpitations in women can be related to hormonal changes (menstrual cycle, pregnancy, perimenopause) and are frequently benign, but cardiac causes must still be excluded 2

Bottom Line

Feeling palpitations more when lying on the left side is a common and usually benign phenomenon related to the heart's proximity to the chest wall in that position 1, 2. However, if these palpitations are new, worsening, or accompanied by any concerning symptoms (dizziness, chest pain, shortness of breath, syncope), you should seek medical evaluation with at minimum a history, physical exam, and 12-lead ECG 4, 5.