Chapter 45 - Feeling shaky with palpitations: Hypertension, tachycardia, dizziness, and near syncope

Abstract

A tremor is uncontrollable shaking or trembling, more precisely defined as a rhythmical, involuntary oscillatory movement of a body part(s). The differential diagnoses for tremor include essential, physiologic, psychogenic, intention, dystonic, neuropathic (due to peripheral neuropathy), orthostatic, and drug-toxin-induced tremor, and midbrain and cerebellar pathologies, e.g., Parkinson's disease and Wilson's disease. Assessment should include the following: distinguishing tremor at rest from that during an action/movement; documentation of the body sites affected; description of the frequency, rhythm, and amplitude of the tremor; determination of any neurological signs and symptoms; and identification of aggravating and alleviating factors. Sympathetic autonomic dysfunction has been found to be highly prevalent in cohort and case-control studies of people with the most common form of tremor, essential tremor. Likewise, people with hyperadrenergic postural tachycardia syndrome (POTS) and hypertension often have a tremor while upright. This chapter describes such a case in a person found to have hypermobile Ehlers-Danlos syndrome. The reader is directed to chapters discussing POTS, dystonia, mast cell activation syndrome (MCAS), and syncope.