Brief Answer: please see details. Detailed Answer: Dear Sir Since two stress tests have been performed and nothing abnormal was found, the possibility of this being a serious life threatening issue is unlikely. However symptoms are significant as mentioned by you. A forceful or hard beat has two basic mechanisms. Either it is premature beat followed by long pause leading to a forceful beat or there are conditions associated with high volume. Your question do not clarify that if this forceful heart beat is occasional or continuous? For diagnosing this we normally advise 24 hours ECG monitoring called Holter monitoring. If it is correlated that your symptoms occurred when you have premature beats, possibly treatment will not be difficult. The common conditions which produce volume overload are hyperthyroid state, anemia, liver disease, kidney diseases etc but they tend to produce prolonged symptoms. cardiac conditions include aortic valve leak, patent ductus and absence of left pericardium, but these must have bee ruled out. Hope this gives some insight. Please feel free to discuss further. Sincerely Sukhvinder

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