Brief Answer:
Differential diagnosis and approach

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. Your hands are shaking or having "tremors". Tremors in hands are of many types

- Coarse tremors means vigorous shaking. It can be tremors at rest (without work) or intentional tremors (occurring only while doing dome work from hands) or mix of two. Resting tremors could be due to Parkinson disease. Intentional tremors could be due to cerebellar disease (ischemia/tumor/injury), B12 deficiency. Combined tremors could be due tor ed nucleus damage in brainstem (ischemia/infection/injury/tumor).

- Fine tremors means rapid, fine alternating movements of fingers. It is usually seen with anxiety, excessive caffeine intake, hyperthyroidism or without any cause (essential).

In your case, history is very small. I request you to provide some details about your complaints to find out the type of tremors and then decide about probable differential diagnosis. You have mentioned about open heart surgery. Possibility of ischemic lesion is quite high in you. Few questions which need to be answered

- What is the type of tremors? fine or coarse.

- Is tremors occur during rest or work?

- What are the drugs, you have been taking other than Amiodarone?

- Is there any past history of stroke?

- Is there any history of anxiety, severe mental stress, excessive coffee/tea drink?

- Does anybody advise you MRI brain? If it has been done, please send the films or report.

Hope you got my point. If any doubt, do let me know.
Thanks. Take care.

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Brief Answer:
History interpretation and approach

Detailed Answer:
Hi XXXX, welcome back.


Sorry for the delay. Thank you for providing me the detailed history. Your history is suggestive of fine tremors, persisting throughout. You have mentioned that there is no history of anxiety. Other causes of fine tremors which need to be ruled out, are

- Hyperthyroidism
- Excessive caffeine intake
- Essential
- Adrenaline excess e.g. Pheochromocytoma, autonomic dysfunction.
- Drugs like antipsychotics, eltroxin etc.

In your case, to confirm diagnosis, few investigations are needed

- Thyroid function test
- MRI brain
- Baseline pulse rate, blood pressure, breathing rate to rule out autonomic dysfunction. If some problem, urine VMA levels can help in confirming the adrenaline hyper-secretion.
- It is less likely to be due to drug induced in your case.
- If everything comes normal, diagnosis of essential tremors should be kept.

Message me the reports of investigations. I will guide you further, Till then, you can

- Take tablet Propranolol instead of Metoprolol. It will reduce tremors along with BP.

- Avoid tea/coffee

- Do Yoga and meditation to calm yourself and control your nerves

- Avoid excessive stressful activities (both mental and physical).

- Even still no relief, Tab clonazepam can be taken after prescription.

Hope it will help. If you have nay doubt, do let me know.
Thanks. Take care

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