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The haemodynamic, histopathological and hormonal features of alcoholic cardiac beriberi
Insights
Cardiac beriberi, a form of heart failure in chronic alcoholics due to thiamine deficiency, can present with biventricular failure and elevated cardiac output. Diagnosis and treatment involve thiamine supplementation, with histological changes noted in myocardial biopsies.
Area of Science:
- Cardiology
- Nutritional Science
- Internal Medicine
Background:
- Cardiac beriberi is a potentially reversible cause of heart failure.
- Chronic alcoholism is a significant risk factor for thiamine deficiency.
- The condition may be underdiagnosed in clinical practice.
Purpose of the Study:
- To describe clinical and pathological findings in five cases of cardiac beriberi.
- To evaluate diagnostic methods, including hemodynamic studies and myocardial biopsy.
- To assess the incidence and characteristics of cardiac beriberi in chronic alcoholics.
Main Methods:
- Clinical case series of five chronic alcoholics with suspected cardiac beriberi.
- Diagnostic workup included hemodynamic measurements, left ventriculography, coronary angiography, and endomyocardial biopsy.
- Thiamine deficiency was assessed via dietary intake and response to thiamine therapy.
- Transketolase assay and response to intravenous thiamine during catheterization were utilized.
Main Results:
- Patients presented with biventricular failure, elevated cardiac output, and depressed left ventricular function.
- Endomyocardial biopsies showed histological changes including vacuolation, edema, hypertrophy, fibrosis, and cellular infiltration.
- No specific beriberi lesion was identified histologically, but biopsies were quantitatively abnormal.
- Plasma renin, angiotensin II, and aldosterone levels were lower than in low-output heart failure.
Conclusions:
- Cardiac beriberi is a significant cause of heart failure in chronic alcoholics, potentially more common than realized.
- Clinical diagnosis relies on biventricular failure, low thiamine intake, and response to thiamine.
- Hemodynamic studies, transketolase testing, and myocardial biopsy aid in diagnosis and understanding pathophysiology.
Abstract:
Five cases of cardiac beriberi occurring in chronic alcoholics are described. The clinical diagnosis was based on the presence of biventricular failure, low dietary intake of thiamine and the therapeutic response to oral thiamine. Complicating cardiac disease was excluded by haemodynamic studies, left ventriculography; coronary angiography and endomyocardial biopsy. Haemodynamic measurements including quantitative left ventriculography are reported. They indicate that left ventricular function is depressed despite elevated cardiac output. Biopsy material was studied by light and electron microscopy. No lesion specific to beriberi was detected by either technique although the biopsies were quantitatively abnormal. The histological changes resemble those in early reports based on necropsy material, and consist of vacuolation and intercellular oedema in the early stages with myofibre hypertrophy, fibrosis and cellular infiltration in the chronic cases. The transketolase test and response to intravenous thiamine during catheter studies are valuable diagnostic tests. Plasma renin, angiotensin II and aldosterone levels were lower than in patients with low output heart failure. The incidence of cardiac beriberi appears to be greater than is generally realized.