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

### input:
Hi, I am a 43 year old female, quite frequently when I am sleeping as my alarm clock goes off I feel a wavelike sensation in (I would say in my heart) upper chest. it feels like when you drop a pebble in a still water and you see it make those wavelike motion until it stops. Whenever I feel it I usually tells myself to calm down, keep still it will pass. In my sleep I like to think I control it up to 3 seconds or minutes I cant tell because most times I fall back to sleep. If I jump up the pain will be more severe and I tend to lose consciousness maybe for a minute.

### output:

Hello! Thank you for asking on Chat Doctor! Regarding your concern, your symptoms may be related to anxiety. You should know that it is a big psychological stress for the brain to wake up from sleep(which is total relax) to alert state, especially from an alarm clock. It causes an immediate increase of catecholamines in your blood, which induce sudden tachycardia and even ectopic beats and difficulty breathing. A phobia from the alarm clock (maybe related to an event in the past), may cause such reaction. But a cardiac arrhythmia can't be excluded, especially when mentioning the loose of consciousness (it can happen during a panic attack too). I recommend consulting with your GP for a careful physical examination, a resting ECG, a chest x-ray and some routine lab tests (complete blood count, blood electrolytes, fasting glucose, kidney and liver function tests). An ambulatory 24-hour ECG monitoring may be necessary to exclude possible cardiac arrhythmia. I would also advise avoiding the alarm clock, or to change its sound. You can use the radio for this purpose. If you don't have any symptoms when avoiding these stimuli (the alarm clock sound), it is probably just anxiety. Hope to have been helpful! Best wishes, 