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Beriberi cardiomyopathy
W Djoenaidi1, S L Notermans, G Dunda
1Department of Neurology, Airlangga University, Faculty of Medicine, Dr Soetomo Hospital, Surabaya, Indonesia.
Insights
Beriberi, a thiamine deficiency disease, remains endemic in Indonesia. Prompt thiamine treatment significantly improved cardiac beriberi symptoms and polyneuropathy, highlighting the importance of early diagnosis and intervention.
Area of Science:
- Nutritional Neurology
- Cardiology
- Clinical Medicine
Background:
- Beriberi remains an endemic health concern in Indonesia, with subclinical cases frequently observed.
- Cardiovascular complications, particularly chronic non-alcoholic cardiac beriberi, pose a significant clinical challenge.
- Shoshin beriberi represents a severe, classical manifestation of thiamine deficiency.
Observation:
- Three patients presented with diverse beriberi manifestations: Shoshin beriberi and chronic cardiac beriberi.
- All patients exhibited dramatic improvement in cardiac symptoms following treatment with thiamine tetrahydrofurfuryl disulfide.
- Polyneuropathy showed some improvement, correlating with neurophysiologic findings and somatosensory evoked potentials (SSEPs).
Findings:
- Somatosensory evoked potentials (SSEPs) offer valuable clinical insights into beriberi-related polyneuropathy.
- Thiamine treatment demonstrated efficacy in reversing both cardiac and neurological deficits associated with beriberi.
- Untreated cardiovascular beriberi carries a high mortality rate.
Implications:
- Routine thiamine administration should be considered for patients with unexplained heart failure.
- Early detection and treatment of beriberi can prevent severe cardiac and neurological sequelae.
- SSEPs can aid in the objective assessment and monitoring of beriberi polyneuropathy.
Abstract:
In Indonesia beriberi is still endemic, but subclinical cases are not uncommon. Three patients suffering from beriberi presented with different clinical manifestations. One had the classical features of Shoshin beriberi and the other two had the non-alcoholic cardiac beriberi (chronic type). The cardiac symptoms of all three patients responded dramatically to thiamine tetrahydrofurfuryl disulfide; there was also some improvement of their polyneuropathy, consistent with the neurophysiologic findings and somatosensory evoked potentials (SSEPs). We conclude that SSEPs provide additional clinical information on beriberi polyneuropathy. The mortality of untreated cardiovascular beriberi is high. In view of the harmless nature of the treatment, a good case could be made for routine administration of thiamine to all patients in whom heart failure is present without clear evidence of the cause.