What are the causes for random heart flutters?

Question

Hi doctor,

For just under the past year, I have been getting random heart flutters as well as random pains in both my left and right ribs. It varies from heart attack-feeling pain to tiny, sudden, dull pain. It goes away quickly but seems to be almost constant now and worsens when I lie down in various positions.

The heart flutters happened at first when I would lie on my back propped up, but now occur anytime I make sudden movements or go from sitting, lying, or standing to a new position. I do not know if they are related, but I am beginning to get scared. I do smoke nicotine, but I do not even know that it is from that.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Thank you for sharing these detailed symptoms. You do not need to panic, but you do need an evaluation soon to rule out the following.

Possible conditions to rule out:

1. POTS (postural orthostatic tachycardia syndrome) or autonomic dysfunction: Sudden heart flutters when changing posture are classic signs. Associated with fatigue, dizziness, anxiety-like symptoms, and chest discomfort. Often missed unless a tilt table test or active stand test is done.

2. Costochondritis or Tietze's syndrome: Inflammation of the rib cartilage can cause sharp, sudden pain, worsened with posture. It can be felt on both sides, but it does not usually cause heart flutters.

3. Mitral valve prolapse (MVP): MVP is common in young women and may cause palpitations, chest discomfort, dizziness, and positional symptoms. It requires an echocardiogram and a Holter monitor to diagnose.

4. Musculoskeletal pain from scoliosis: Scoliosis can strain intercostal muscles, leading to chronic rib pain, especially when lying down or twisting. Nerve impingement can sometimes mimic internal organ pain.

5. Pulmonary embolism: This should be ruled out if symptoms worsen or new shortness of breath appears.

What you need to do:

Tests to request:

ECG (electrocardiogram) – Check for arrhythmias.
24-hour Holter monitor – Check for intermittent palpitations.
Echocardiogram – Evaluate the structure, such as valve issues.
Active stand or tilt table test – To evaluate for POTS.
Chest X-ray – To rule out musculoskeletal or lung issues.
D-Dimer – To rule out a clot.

What you can do now:

Stop nicotine if possible. It worsens palpitations, increases blood clot risk (especially with birth control), and can sensitize your nervous system.
Start tracking your heart rate and symptoms when you change posture; a smartwatch or phone application can help.
Hydrate well and increase salt intake slightly.
Avoid lying flat if symptoms worsen.
Prop yourself up with a pillow.

Consider asking your doctor to rule out POTS; even a general physician can begin the screening.

I hope this information will help you.

Thanks.