Overview
Cardiac beriberi, caused by severe thiamine (vitamin B1) deficiency, manifests primarily as wet beriberi with cardiac dysfunction, including high cardiac output, low systemic vascular resistance, and potential right-sided heart failure 1267. It can occur post-gastric surgery, in malnourished states, and among populations with restricted dietary intake or social isolation 14.Diagnosis
Clinical Presentation: Symptoms include dyspnea, edema, palpitations, nausea, vomiting, and signs of heart failure 12467.
Hemodynamic Indices: High cardiac output and low systemic vascular resistance are indicative 267.
Laboratory Tests: Low serum thiamine levels are crucial for diagnosis 25.
Specific Conditions: Consider in patients with a history of malnutrition, gastric surgery, alcoholism, or social withdrawal 1467.
Differential Diagnosis: Rule out other causes of heart failure and elevated lactate 5.Management
Thiamine Supplementation: Intravenous thiamine is first-line, with doses varying but often including bolus administration 267.
Supportive Care: Manage heart failure symptoms with standard therapies, adjusting based on hemodynamic response 267.
Dietary Intervention: Ensure adequate thiamine intake post-surgery or in malnourished states 1.
Monitoring: Regular assessment of thiamine levels and clinical improvement 5.Special Populations
Post-Gastric Surgery Patients: Increased risk due to altered nutritional absorption; require close monitoring and supplementation 1.
Alcoholism: High risk for thiamine deficiency leading to severe forms like shoshin beriberi 67.
Social Isolation (Hikikomori Syndrome): Potential for thiamine deficiency due to restricted dietary intake 4.Key Recommendations
Prompt Recognition and Thiamine Supplementation: Recognize subclinical thiamine deficiency, especially post-gastric surgery, and administer thiamine promptly to prevent morbidity and mortality (Evidence: Strong 1).
Consider Thiamine Deficiency in Non-Specific Cardiomyopathy: Include thiamine deficiency in the differential diagnosis for patients presenting with non-specific heart failure symptoms, particularly with hemodynamic instability (Evidence: Moderate 267).
Enhanced Nutritional Follow-Up: Implement rigorous nutritional follow-up protocols for patients post-gastric surgery to prevent beriberi (Evidence: Expert opinion 1).References
1 Wilson RB. Pathophysiology, prevention, and treatment of beriberi after gastric surgery. Nutrition reviews 2020. link
2 Lei Y, Zheng MH, Huang W, Zhang J, Lu Y. Wet beriberi with multiple organ failure remarkably reversed by thiamine administration: A case report and literature review. Medicine 2018. link
3 Lonsdale D. Thiamin. Advances in food and nutrition research 2018. link
4 Tanabe N, Hiraoka E, Kataoka J, Naito T, Matsumoto K, Arai J et al.. Wet Beriberi Associated with Hikikomori Syndrome. Journal of general internal medicine 2018. link
5 Duca J, Lum CJ, Lo AM. Elevated Lactate Secondary to Gastrointestinal Beriberi. Journal of general internal medicine 2016. link
6 Imamura T, Kinugawa K. Shoshin Beriberi With Low Cardiac Output and Hemodynamic Deterioration Treated Dramatically by Thiamine Administration. International heart journal 2015. link
7 Kim J, Park S, Kim JH, Kim SW, Kang WC, Kim SJ. A case of shoshin beriberi presenting as cardiogenic shock with diffuse ST-segment elevation, which dramatically improved after a single dose of thiamine. Cardiovascular journal of Africa 2014. link
8 Jukes TH. The prevention and conquest of scurvy, beri-beri, and pellagra. Preventive medicine 1989. link90023-6)