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Q: I have developed a tremor in both my hands. It gets worse when I get nervous. Is this the start of Parkinson’s disease? Can it be treated?

A: It’s not surprising that you associate tremor with Parkinson’s disease. But it is much more likely that you have essential tremor, a very common disorder.

Tremor is the shaky movements of your hands, limbs, head or voice that you can’t control. Sometimes tremor is a normal reaction to a situation, such as fear, fatigue or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from alcohol, a drug or medicine. When a tremor occurs during activities, and there is no emotional or chemical cause, essential tremor is a likely possibility.

Essential tremor is different from Parkinson’s disease. Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. The shakiness is often called an “intention tremor” because it worsens when a person is trying to do something.

In contrast, people with Parkinson’s watch their hands shake when they rest in their lap. But when they reach out to grab or hold something, such as a cup of coffee, the shaking stops.

Essential tremor usually starts in mid-life or later. As many as one in four people develop essential tremor as they age.

The name of this condition indicates that the cause is unknown and that it occurs on its own, without another explanation. You are more likely to develop essential tremor if you have a parent or sibling with the condition. In fact, genetic mutations have been linked to “benign familial tremor.”

The most common initial symptom is shaking of the hands, but other areas, including the arms, legs and head, are frequently involved. A trembling voice may be a symptom of essential tremor.

For mild symptoms, no treatment is needed. Avoiding caffeine and stress and getting plenty of rest can be helpful.

However, for symptoms that impair quality of life, most doctors prescribe either a beta blocker, usually propranolol, or primidone, an anti-seizure medicine. If the initial choice doesn’t work well enough, you can try the other, and sometimes taking both helps the most. Alternative medications are topiramate and gabapentin. Both are anti-seizure drugs but are often used for other indications, such as migraine and chronic pain.

Q: I get chest heaviness if I walk too fast or get excited. It goes away quickly when I stop or calm down. I think I have angina. Will I need to have a stent or surgery?

A: Your symptoms suggest that you have stable angina. But you definitely need to call your doctor to arrange a thorough medical evaluation of your symptoms.

If your doctor confirms it is angina, most likely it is due to coronary artery disease. Angina happens when the network of arteries that nourish the heart are narrowed by fatty and calcified plaque, a condition called atherosclerosis. The classic symptom — chest discomfort during physical exertion — is known as stable angina because it occurs in a predictable pattern.

For decades, cardiologists debated the best way to treat this problem: a procedure to reopen the artery (angioplasty and a stent) or optimal medical therapy medication.

The rationale for doing angioplasty on people with stable angina came from a long-held assumption that turned out to be wrong. Until about 30 years ago, the collective opinion was that atherosclerosis was an inexorable, progressive disease that would eventually cause a heart attack.

Doctors now recognize that most heart attacks occur in arteries that are only about 30% to 40% blocked but harbor so-called vulnerable plaque that ruptures without warning. The resulting blood clot blocks blood flow, triggering a heart attack.

Several major trials confirm that for people with stable angina, stents don’t offer any advantage over optimal medical therapy when it comes to preventing heart attacks or death.

Medications help treat (and perhaps stabilize and even reverse) atherosclerosis in all the heart’s arteries, whereas stents address only specific spots. Drug therapy is also less expensive and has fewer serious side effects.

Understandably, people with stable angina worry about having a fatal heart attack. But studies show that the risk is low — only about 0.4% per year in people who are careful to address all their risk factors. That means not smoking, eating a healthy diet with plenty of plant-based foods, getting regular exercise and managing stress, in addition to taking the right combination and doses of medicines.

In contrast to stable angina, unstable angina tends to occur without warning, with only slight exertion or even when you’re resting or sleeping. Angina that becomes more frequent, worsens or lasts longer than usual is considered unstable and may signal a heart attack. If your chest discomfort or other symptoms don’t get better within 10 minutes, call 911.

© 2023 Harvard University. Distributed by Tribune Content Agency, LLC.