<s>[INST] I am 42 female, with no history of heart problems. When I was a child a heart murmur was dectected but not heard in a very long time. I rarely have palpitations but today I have had them a few times and my right arm is achy and tingly. should I be concerned. I am 5 and 254lbs. [/INST] Thanks for your question on Chat Doctor. I can understand your concern. Possibility of stress and anxiety related symptoms is more. But since you had heart murmur in childhood, we should rule out arrhythmia (rhythm disturbances in heart) for your palpitations and tingling arm sensations. So get done ECG, 2d echo and Holder monitoring (24 hours continuous recording of ECG). If all these are normal then no need to worry about arrhythmia or other heart diseases. You are approaching menopause. So hormonal imbalance is likely and this can further add stress and anxiety. So get done hormone levels and if imbalance then you will need hormone replacement therapy (HRT). Also consult psychiatrist and get done counselling sessions. Try to identify stressor in your life and start working on its solution. You may need anxiolytic Chat Doctor.  Don't worry, you will be alright with all these. Avoid stress and tension, be relaxed and calm. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks. </s>