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Fulminant heart failure due to selenium deficiency cardiomyopathy (Keshan disease)
Michael Philip Burke1, Kenneth Opeskin
1Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Southbank, Australia.
Insights
Selenium deficiency, though rare, can cause cardiomyopathy, a serious heart condition. This study highlights Keshan disease, a selenium-deficiency cardiomyopathy, in a patient with malabsorption.
Area of Science:
- Cardiology
- Nutritional Science
- Forensic Pathology
Background:
- Selenium deficiency is a rare etiological factor for cardiomyopathy.
- It is linked to myopathy and osteoarthropathy, notably Keshan disease and Kashin-Beck disease in specific regions.
- Chronic deficiency can arise from malabsorption or inadequate parenteral nutrition.
Observation:
- A case of fulminant heart failure in a middle-aged woman is presented.
- The patient had a complex medical history, including documented malabsorption and selenium deficiency.
- Autopsy revealed pathological cardiac findings consistent with Keshan disease.
Findings:
- The study confirms selenium deficiency as a cause of cardiomyopathy.
- Keshan disease, a specific cardiomyopathy linked to selenium deficiency, was identified pathologically.
- The case underscores the importance of considering nutritional deficiencies in heart failure.
Implications:
- Forensic pathologists should consider selenium deficiency in unexplained cardiomyopathy cases.
- This highlights the critical role of selenium in cardiac health and the potential for severe outcomes with deficiency.
- Understanding these links can improve diagnosis and management of heart failure in at-risk populations.
Abstract:
Selenium deficiency is a rare cause of cardiomyopathy that may be encountered by the forensic pathologist. Selenium deficiency is associated with a cardiomyopathy, myopathy and osteoarthropathy. In Asia and Africa, dietary selenium deficiency is associated with a cardiomyopathy known as Keshan disease and an osteoarthropathy called Kashin-Beck disease. Chronic selenium deficiency may also occur in individuals with malabsorption and long term selenium-deficient parenteral nutrition. Selenium deficiency causes myopathy as a result of the depletion of selenium-associated enzymes which protect cell membranes from damage by free radicals. We present a case of fulminant heart failure in a middle aged woman with a complex medical and surgical history including documented malabsorption and selenium deficiency. Pathological examination of the heart showed features consistent with Keshan disease.