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The symptom of palpitations is suggestive of cardiac arrhythmia but may have a non- cardiac cause. Palpitations not related to emotion, fever and exercise suggest an arrhythmia. There are many pitfalls in the diagnosis and mangaemnet of arrhythmias especially in the elderly where symptoms of infection can be masked. Palpitations associated with menopause maybe overlooked. Valvular lesions usually associated with rheumatic heart disease such as mitral stenosis and aortic incompetence may cause palpitations. The rare tumour, pheochromocytoma, presents with palpitations and postural tachycardia. The toxin from tick bites in dermatomes T!- 5 can also cause palpitations.
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