Cryptic crossword clue
Hospital patient’s heart to pound; one in bed, perhaps is not so flat 7

The most common and most likely answer to this crossword clue is the 7 letter word HILLIER

I've seen this crossword clue in The Guardian
H
I
L
L
I
E
R

Buddy explains!

The straight part
We know that "not so flat" is the straight/definition part of the clue. The straight part is often a synonym or definition, in this case not so flat = hillier.
The cryptic/wordplay part
In cryptic crossword there's often an wordplay/cryptic part as well.
This part involves a more complex hint, such as an anagram, homophone, hidden word, etc.
Sadly, We don't have an explanation for this specific crossword clue yet.

What does HILLIER mean?

HILLIER adjective
  1. (of a landscape) Abundant in hills; having many hills.

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