<s>[INST] Hi. My son is having heart palpitations for the last couple of months. His blood work came back fine and the EKG. He has an upper left side rib that is out of place and he went to a chiropractor 3 times and is still having problems with rib out of place. He is also having problems with the heart palpitations. He is not short of breath and blood pressure is normal. We recently went to a cardiologist and he is now wearing a holt monitor for 48 hours and then an echocardiogram scheduled for the 19th. My question is could the rib being out of place in the upper chest cause this problem of the heart issues?? [/INST] Thanks for your question on Chat Doctor. I don't think improper rib attachment in upper chest cause palpitations in heart. It will cause pain but not palpitations. Palpitation can be due to arrhythmia, thyroid diseases, anemia or stress and anxiety. So to rule out arrhythmia holder monitoring (24 hour continuous recording of ECG) and 2D Echo is necessary. If both of these are normal than get done1. CBC (Complete Blood Count) to rule out anemia. 2. Thyroid function test to rule out thyroid diseases. If these are also normal then it must be stress and anxiety related. So ask him to avoid stress and tension.  Be relax and calm. </s>