Cardiac beriberi: two modes of presentation.

Area of Science:

• Cardiology
• Nutritional Science
• Internal Medicine

Background:

• Cardiovascular beriberi, a severe manifestation of thiamine deficiency, often presents with high-output heart failure.
• A rare variant, shoshin beriberi, can mimic low-output heart failure, posing diagnostic challenges.
• Untreated cardiovascular beriberi carries a high mortality rate.

Purpose of the Study:

• To highlight the diverse clinical presentations of cardiovascular beriberi.
• To emphasize the importance of recognizing shoshin beriberi, a rare but critical form.
• To underscore the efficacy of thiamine in treating all forms of cardiovascular beriberi.

Main Methods:

• Case report of two patients with cardiovascular beriberi.
• Clinical assessment of cardiac output and fluid status.
• Monitoring response to thiamine hydrochloride administration.

Main Results:

• Patient 1: Classical high-output heart failure with edema, responded to thiamine.
• Patient 2: Fulminating low-output heart failure (shoshin beriberi) without edema, responded dramatically to thiamine.
• Both cases demonstrate the critical role of thiamine in reversing severe cardiac dysfunction.

Conclusions:

• Cardiovascular beriberi requires consideration in heart failure diagnosis, irrespective of cardiac output.
• Shoshin beriberi, though rare, is a life-threatening presentation of thiamine deficiency.
• Early thiamine repletion is essential for favorable outcomes in cardiovascular beriberi.