<s>[INST] Hi Doctor my wife has paptation problem, recently i take ECG and the pulse previous 195, and then it reduce to 113 and normal, ca u advice me why the paptation problems create, please advice me what to do. she's age 25.mother of 1 kid and now shes pregnant 8 monthsregards [/INST] Hello!Welcome and thank you for asking on HCM!I understand your concern and would explain that her palpitations are related to the high heart rate. This clinical scenario may be related to a metabolic disorder (thyroid dysfunction, anemia, inflammation, etc.) or a cardiac arrhythmia. Anxiety could also be associated to this clinical situation. I recommend consulting with your GP for a careful physical examination, a resting ECG and cardiac ultrasound , a chest X ray study and some blood lab tests : -complete blood count (for possible anemia)-blood electrolytes-fasting glucose-kidney and liver function tests -thyroid hormone levels-PCR and sedimentation rate (possible inflammation). An ambulatory 24-48 hours ECG monitoring is necessary to examine her heart rate trends. Hope to have been helpful!Best regards!Dr. Iliri </s>