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

### input:
Hi. Last night and again today, I ve noticed a large and noticeable pulsation in my neck in the area of the carotid artery. It s especially pronounced when I m supine. This afternoon, while at work, I noticed the pulsations in my neck and then, shortly after, realized my right hand was shaking and the arm felt weak. It subsided after a few minutes. When I returned home this evening, I noticed the beating in my neck and, using a video camera on my phone, confirmed the pulsations are visible and most visible when I m lying down or back on pillows. I feel okay otherwise, although my arm and shoulder again feel a little strange. (Although, truthfully, I m wondering if I m just reading into things a little bit.) I do have a history of heart issues: I had a patent foramen ovale closed in my heart in 2010 due to several years worth of strange symptoms (visual, pins & needles, etc.) that were likely ongoing and sporadic TIAs, according to my cardiologists. I have had no repeat episodes since the surgery, although have had a few cases of pericarditis since then. Otherwise, I am in excellent health/fitness. Weight ~130. Height ~5 6 . Physically active, no drug use, occasional social alcohol use. No family history of cardio disease. The question: should I be concerned about these symptoms and go to the ER, or is it normal? Or, somewhere in between those two extremes?

### output:

HIF you see carotid pulsations or jugular vein pulsations and felt weakness of arm simultaneously and with history of heart operation, you may consult a cardiologist for it. You may also watch if you get rapid pulse or irregular radial pulse, some symptoms of dizziness or not.I may suggest an echocardiogram to record the chamber functions, valves and pressure gradients to rule out any abnormalities of atria and ventricle size