<s>[INST] Hi, doctor. I m writing on behalf of my elderly mother who doesn t know how to write. She has been experiencing intermittent palpitations that occur sometimes after she eats or in the middle of the night when she is asleep. They are so alarming that she awakens. She takes her blood pressure measurement when this happens and usually her pulse is elevated. The longest episode has been approx. 4 hours. Her medical history is: high blood pressure, tachycardia, thyroid, osteoarthritis and some stomach problems. She takes medication for all. The palpitations frighten her and she wants to know if they are serious to her health or if they will increase her chances of heart attack or stroke. All her medical tests are normal. I have limited information as I don t live with my mother. Thank you in advance. [/INST] Hi, From your mothers' data, it seems that there are certain factors which could be the source of her palpitations. In particular, thyroid disease and hypertension can cause palpitations. And both needs work-up to check for complications of chronic hypertension leading to heart failure or thyrotoxicosis/hypothyroidism. This would require thyroid function tests and probably a 2D echocardiogram to check for heart function and structural changes. I highly recommend a check-up with your doctor to check for other signs seen in your mother which would support either of the two possible causes of your mothers palpitations. As well, the doctor would be able to discover any other causes, as your mother is examined. And this would direct treatment, depending on the results. Hope I have answered your query. Let me know if I can assist you further.  </s>