** Thanks for contacting HCM with your health concern 1. You should consult with a Cardiologist to exclude following symptoms: i. Anxiety is the commonest cause of heart flutter but first one should exclude: . Hyperthyroidism (Thyroid function test) . Arrhythmias (ECG & Holter monitoring) . Left Ventricular Hypertrophy (Chest X-ray) . Diabetes (blood sugar to exclude hypoglycemia) . Anemia (Hemoglobin level) PS. Check with a Cardiologist for ADR [adverse drug reaction] of Metoprolol [if any] and although lexapro [escitalopram] has been known to cause heart palpitations but rule any physical cause first. 2. If pulse & heart appear normal then the most important cause will be anxiety and will be managed accordingly. 3. Avoid excess of tea/coffee . Avoid alcohol & smoking . Avoid mental strain. 4. Take tablet Stressan or Mentat or Brahmi vati: 2 tablet at bed time 5. you may ask for electrolyte, fluid and glucose values