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The surprise ending comes when our main character is so plagued by the beating of his own heart, which he perceives to be the murder victim's, that he tears up the floorboards to expose his crime to the law enforcement officers on scene. Throughout the story, our protagonist battles with the beating heart, until at last he can stand no more, and reveals the dismembered body he has concealed beneath the planks of his own floor. As we gain a perspective inside our character's mind, we get to experience a small piece of his insanity. Poe was good at using the first person to engross his readership.
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