### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have had palpations for a while I think it maybe due to stress and the fact that i am going through the the peri -menopausal state at the moment. Although I have been through a trying time at the moment as my daughter gave birth to stillborn banck in April and my other daughter is 30weeks pregnant and understandbly distressed. I am also finding it hard as I work full time, please can you offer any advice as to how to cope. it would be greatly appreciated. Karen Deacon

### output:

Hi, Thanks for posting your query. You are suffering from palpitation, and it is essential to find the cause. Palpitation may be due to heart problem or may be due to hormonal problems. If cardiac and non-cardiac evaluation is normal then you may have panic attacks. Do you have fever/ increased sweating/ watery shit/ weight loss? Do you have squeezing sensation/ sweating/ difficulty in respiration/ respiratory difficulties with change of posture/ swelling in feet ? Have you undergone thyroid profile/ serum electrolytes/ ECG for heart previously? What are their reports? You should consult with physician / cardiologist and should go for following investigations: complete blood count, serum electrolytes, thyroid profile, renal function test, epinephrine, norepinephrine and urinary VMA level, ECG, 2 D echo and coronary angiography if needed. Palpitation may be cardiac problems such as PCs, APC, PSV, Junctional rhythm, ventricular Gemini and trigeminal. These heart diseases may be diagnosed by ECG and holder monitoring for 48-72 hours. If still not helpful then you can go for electro-physiological studies of heart. Hormonal disorders may be thyroid disorders and pheochromocytoma. These disorders may be diagnosed by above-mentioned hormone analysis test. As you have history of family MIS happening, there may be possibilities of panic attacks, GAD and PTSD. You should consult with psychiatrist in such case. Take care,