Beriberi Heart Disease

BERIBERI HEART DISEASE IS CAUSED BY SEVERE
thiamine deficiency. This disease is most prevalent in the
Far East, however, in the past decade its prevalence has
markedly decreased. It occurs mainly in individuals whose
staple diet consists of polished rice that is deficient in
thiamine but high in carbohydrates.
Diets with a high carbohydrate content require a greater
intake of thiamine. White bread enriched with thiamine
has helped in this respect. Because alcohol is high in carbohydrate
content but deficient in thiamine, some alcoholics
become thiamine deficient and weakness of the heart muscle
may occur. The disease is also common in fad dieters.

I. CLINICAL MANIFESTATIONS
Swelling of both legs is caused by edema and may become
severe. Pitting edema of both legs may extend up to the
thighs and over the trunk. The heart becomes dilated and
weakness of the muscle progresses to heart failure. Beriberi
heart disease may cause sudden cardiac dysfunction within
days of onset of symptoms. This condition is accompanied
by low blood pressure, tachycardia, and lactic
acidosis. Patients may die within hours or within days of
cardiogenic shock and pulmonary edema.
On laboratory diagnosis for Beriberi heart disease serum
pyruvate and lactic acid levels are increased. The ECG
shows low-voltage QRS complex and prolongation of the
QT interval. Chest x-ray usually shows dilatation of both
ventricles and congestion of the lungs with pleural
effusions.

Treatment including administration of 100 mg of IV
thiamine, then 25 mg daily for about 2 weeks causes
dramatic improvement. Although the initial treatment
does not require digoxin and diuretics, a few days after
starting thiamine therapy digoxin and diuretics are
indicated and produce beneficial results. Disturbance of
nerves in the legs often accompanies the heart symptoms
and thiamine replacement improves this type of polyneuropathy.

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