Such palpitations are extra-cardiac in nature, that is, palpitation originating from outside the heart itself. Tachycardia may result in palpitation; however, tachycardia is not "necessarily" an arrhythmia. However, some side effects can occur, such as palpitation, tremor, elevated blood pressure, and anxiety. However, flushing, palpitation, and hypotension were significantly higher in the nifedipine group. Accordingly, vagus nerve induced palpitation is not evidence of an unhealthy heart muscle. Beyond basic inspection, physicians used palpitation, percussion and auscultation to identify abnormalities. Al-Jurjani also established an association between goitre and palpitation. Similar to a tinel sign digital palpitation of the ischial spine may produce pain. However, doctors dismissed it as merely a heart palpitation. Treating palpitation will depend on the severity and cause of the condition. On 20 September 1837 he suffered "an uncomfortable palpitation of the heart". Before necropsy takes place, diagnosis by palpitation can be used to find tubular lesions. If the ki sustains the gesture, the shin modulates its palpitation. The most important initial clue to the diagnosis is one's description of palpitation. Palpitation and pain in the heart were frequent symptoms, as well.