<s>[INST] iam 43 year man and from 10 day iam feeling miss beating in my heart iam daibitic and hypertensiv too and i have psoriasis my blood pressure is under control but my sugar is not in under control i regularly exercise 40 mintue on cycle tell me the cause plz [/INST] Hello! Thank you for asking on Chat Doctor! I understand your concern, and would explain that your symptoms may be related to a cardiac arrhythmia. Based on your cardio vascular risk factors (hypertension, psoriasis and diabetes), a cardiac check up is necessary. I recommend consulting with your attending physician for a careful physical examination, a resting ECG, a chest x-ray and some blood lab tests : - complete blood count-fasting glucose and HbA1C- PCR, sedimentation rate-kidney and liver function tests-blood electrolytes- thyroid hormone levels, etc. An ambulatory 24 -48 hour ECG monitoring and a cardiac ultrasound are necessary to rule in/out a possible cardiac arrhythmia. Hope to have been helpful! Best regards,  </s>