Trembling hands and feet

Introduction -receptor hyperthyroidism is a normal secretion of endogenous catecholamines, and -receptors are overly sensitive to their stimulation, resulting in increased heart rate, increased ventricular contractility and increased cardiac output, and -receptors. The blocker treatment is effective. There are signs of anxiety, but most of the appearance is still good. There are hand and foot trembling and tendon reflex enhancement. The cause is not completely clear. It is generally believed that the central nervous system is dysfunctional, leading to imbalance of autonomous (plant) nerves in the onset of stress such as overwork, high tension, and trauma.

Cause

The cause is not completely clear. It is generally believed that the central nervous system is dysfunctional, leading to imbalance of autonomous (plant) nerves in the onset of stress such as overwork, high tension, and trauma.

Pathogenesis:

1. The pathogenesis is thought to be related to the hypersensitivity of the cardiovascular system to catecholamine or sympathetic stimulation. Studies have confirmed that the patient's blood and urine catecholamine levels are normal, after intravenous infusion of isoproterenol, tachycardia and hypertension and other symptoms of high stroke volume are exacerbated, and symptoms of high heartbeat are given after beta blockers. The amount is rapidly improved, thus indicating that it is not an increase in catecholamine secretion but an increase or hypersensitivity of cardiac beta receptor response to catecholamine or sympathetic stimulation.

2, pathophysiological cardiac output depends on heart rate and stroke volume, the latter depends on myocardial contractility, cardiac preload (venous return blood volume, ventricular dilatation) and cardiac afterload (peripheral vascular resistance), and feeling sympathetic And the parasympathetic nerve, blood catecholamine and acetylcholine concentration and body temperature and other factors regulate the normal person under the coordination of the above factors, resting cardiac output at rest, adult heart index is 2.6 ~ 4.0L / (min? m2), physical exercise, emotion Excitement, postprandial and hot and humid conditions can increase, but the change in sleep position has no effect.

an examination

Related inspection

ECG blood pressure

The age of the disease can be 7 to 80 years old, 80% between 20 and 40 years old, more women than men, 3:1 to 6:1. Most of the pre-existing mental factors such as overwork and height Tension, trauma, post-illness, etc., there are also some iatrogenic, and a few have no incentives.

Symptoms are diverse, mainly manifesting cardiovascular and neurological symptoms, chest distention, palpitations, dizziness, fatigue, most common pain in the precordial area, long-lasting chest pain, mostly stinging, followed by low fever, sweating, insomnia, limbs Hemp, consciously short of breath, lack of gas, comfortable after sighing, a few have a short "syncope", pharyngeal obstruction. When standing, nervous and aggravated, lying, nausea and vomiting relieves mild urgency after exertion, but the work is generally unaffected, and if there is heart failure, there will be sitting and breathing.

There are signs of anxiety, but most of the appearance is still good. When the heart rate is at rest, it can be as long as 90 to 100 times/min or more, and the individual can reach 170 times/min. It often changes with standing position or emotional activity, and increases when standing or working. It decreases in lying position or sleep, and the difference between normal adult standing heart rate For (8.23±4.3) times/min, the disease reached (16.95±9.18) times/min. The elderly with a long course of disease may have a mild heart enlargement. The heart beats in the precordial area. The heart beats strongly and quickly auscultates the first heart sound. Some have systolic jet-like sounds, 3rd and 4th heart sounds, and the second sound splits. The first to third grade systolic murmurs of the first to third grades were most prominent on the third and fourth intercostals of the left sternal border, the second intercostal space on the right sternal border, and the external carotid artery. The systolic blood pressure can be slightly increased by 19 to 21 kPa, the pulse pressure is increased, and there is a water pulse lance and a capillary sign. There are hand and foot trembling and tendon reflex enhancement.

Complications: Heart failure can occur on the severe side.

Differential diagnosis

Hand and foot trembling is a common disease but clinically easy to ignore, need to be identified as follows:

1. Hyperthyroidism: ECG changes due to palpitations, tachycardia, hyperhidrosis, insomnia, and hyperthyroidism, similar to this disease, but the difference in cerebral tachycardia is large, and the thyroid is not aggravated with emotional stress. Large, no exophthalmia, normal thyroid function test can be differentiated from hyperthyroidism.

2, myocarditis: this disease is more common in young people, because of heart palpitations, chest tightness, shortness of breath, ECG ST-T changes, premature contraction, and confusing with myocarditis, but this disease often has mental factors before the onset, heart sounds powerful, hormones, rest Symptoms are not improved, and the effect of -blockers is good.

3, cardiac neurosis: isoproterenol, propranolol can help diagnose this disease, can be identified with general neurosis.

4, mitral valve prolapse: because both are palpitations, chest pain, fatigue and dizziness, ECG ST-T changes to propranolol symptoms, it is easy to confuse but the middle and late stage of the contraction, echocardiography and drug test can be Distinguish the two.

5, pheochromocytoma: this symptom due to catecholamine reaction sensitive errors for the catecholamines in the body of pheochromocytoma, but by measuring 24h urine vanillyl mandelic acid, adrenal electronic computed tomography (CT) to help identify.

6, coronary heart disease: especially with high blood pressure, but also pulse pressure, pulse power, ECG ST-T abnormalities, exercise test positive performance. However, the symptoms of this disease are diverse, and the relationship with body position is large. The tachycardia is not compatible with the amount of exercise. It is helpful to identify the symptoms of blockers. However, it should be noted that the two diseases can coexist at the same time, especially some patients with this disease will have coronary heart disease and hypertension at the same time.

7. Other causes of high power circulation, such as anemia, arteriovenous fistula, beriberi, pulmonary heart disease, cirrhosis and carcinoid syndrome, have clear primary symptoms, not difficult to identify.

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