This quote can be attributed to two of Edgar Allan Poe's themes in "The Tell-Tale Heart," those of guilt and insanity. The sounds which "welled up from my bosom" arise from the narrator's guilty conscience, just as the old man's beating heart comes from the murderer's guilt of committing such a gruesome deed. It is one of the uncontrollable forces of nature of which the man's best-drawn plans are immune. The reader must have questioned the murderer's mental state since the first lines of the story, despite the narrator's reassuring pleas that he is sane. None of his actions are those of a sane man, and the reasons given for the decisions he makes further illustrate his madness. He hears sounds that emanate from both heaven and hell, and is filled with "terrors" that distract him, ending with the final roar of the dead man's heart that proves to be his undoing.