Beriberi heart disease

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Wet beriberi

Overview
Beriberi heart disease is a form of BeriBeri called wet BeriBeri that involves the heart. It is caused by severe thiamine deficiency.

Epidemiology
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 diet appliers.

Pathophysiology
Pathologically the heart in cardiac beriberi is most often hypertrophied and dilated, with involvement of both the right and left chambers.

Differential diagnosis of conditions that mimic Wet Beriberi

 * Alcoholic Fatty Liver
 * Alcoholic Hepatitis
 * Alcoholic Ketoacidosis
 * Alcoholism
 * Anemia
 * Anorexia Nervosa
 * California Encephalitis
 * Campylobacter Infections
 * Cardiogenic Shock
 * Cardiomyopathy, Alcoholic
 * Cardiomyopathy, Cocaine
 * Cardiomyopathy, Diabetic Heart Disease
 * Cardiomyopathy, Dilated
 * Cardiomyopathy, Hypertrophic
 * Cardiomyopathy, Peripartum
 * Cardiomyopathy, Restrictive
 * Cholera
 * Cirrhosis
 * Delirium
 * Delirium Tremens
 * Delusional Disorder
 * Dementia Due to HIV Disease
 * Depression
 * Dermatomyositis
 * Diabetic Ketoacidosis
 * Encephalopathy, Dialysis
 * Encephalopathy, Hepatic
 * Encephalopathy, Hypertensive
 * Encephalopathy, Uremic
 * Enterobacter Infections
 * Enteroviruses
 * Folic Acid Deficiency
 * Goiter
 * Goiter, Diffuse Toxic
 * Hepatic Failure
 * Hyperthyroidism
 * Ileus
 * Irritable Bowel Syndrome
 * Metabolic Acidosis
 * Myocarditis
 * Nerve Entrapment Syndromes
 * Polymyositis
 * Schizophreniform Disorder
 * Scurvy
 * Sudden Cardiac Death
 * Thyroiditis, Subacute
 * Trigeminal Neuralgia
 * Vascular Dementia
 * Viral Arthritis
 * Wernicke-Korsakoff syndrome

Signs and symptoms
The clinical manifestations of beriberi heart disease vary considerably with the severity and rapidity of the onset of the condition.

Symptoms of heart failure are more frequently seen. Excessive peripheral edema may occur. Dyspnea, weakness, swelling of the ankles, and a nonproductive nocturnal cough are the most common complaints.

The heart becomes dilated and progresses to heart failure. Beriberi heart disease may cause sudden cardiac dysfunction within days of onset of symptoms. This condition is accompanied by hypotension, tachycardia, and lactic acidosis.

Patients may die within hours or within days of cardiogenic shock and pulmonary edema.

Laboratory Tests
On laboratory diagnosis for Beriberi heart disease serum pyruvate and lactic acid levels are increased.

Electrocardiogram
The ECG shows low-voltage QRS complex and prolongation of the QT interval.

Chest x-ray
Chest x-ray usually shows congestion of the lungs with pleural effusions.

Treatment
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.