Shoshin Beriberi With Vasospastic Angina Pectoris. Possible Mechanism of Mid-Ventricular Obstruction.

Abstract

eriberi heart is a very rare disease today and is caused by thiamin deficiency. 1 Beriberi heart is hemodynamically characterized by high cardiac output failure associated with arteriolar vasodilatation. Shoshin beriberi is a fulminant form of beriberi heart and is characterized by hypotension, tachycardia, and lactic acidosis. [1][2][3][4][5][6][7] Initially, mid-ventricular obstruction had been reported as a special form of hypertrophic cardiomyopathy, but it can be found in other conditions such as myocardial infarction, hypertensive heart disease, and even in normal subjects with alternation of loading conditions. [8][9][10][11][12][13] We report a case of shoshin beriberi and mid-ventricular obstruction of the left ventricle with an apical aneurysm. The patient's left ventricular wall thickness was not hypertrophic, and the aneurysmal site was perfused by the left anterior descending artery, in which spasm was provoked using acetylcholine. Case ReportA 73-year-old man was admitted to hospital suffering from chest pain and adynamia of the limbs. He had a history of inferior myocardial infarction, which was followed by conventional therapy when he was aged 65 years. Thereafter, he frequently experienced angina at rest, especially at night. He was a heavy drinker from his young days and he drank to overcome his anginal chest pain instead of taking medication. His alcohol intake had increased gradually, and he had stopped eating completely and been drinking all day for 1 month prior to admission. His blood pressure on admission was 68/30 mmHg and he was in a state of shock. His first and second heart sounds were normal and, although hepatomegaly was present, bilateral pitting edema was not. The power of his inferior limbs was very weak and his deep tendon reflex had disappeared.An electrocardiogram showed sinus tachycardia with a heart rate of 120 beats/min, and ST depression in leads I, II, III, aVF, and V1-V6, as well as negative T waves in leads II, III, and V1-V3. Echocardiography demonstrated hyperkinesis of the left ventricle and mid-ventricular obstruction with a peak intraventricular pressure gradient of 30 mmHg, but his left ventricular wall thickness was not hypertrophic. Laboratory data were normal except for a slight increase in creatine kinase (CK) (223 IU/L). After administering 3 L/min of oxygen, arterial blood gases revealed a pH of 7.27, pO2 105 mmHg, and pCO2 17 mmHg.Despite massive intravenous administration of catecholamine (dopamine 20 g·min -1 ·kg -1 , dobutamine 20 g·min -1 · kg -1 , and noradrenaline 0.2 g·min -1 ·kg -1 ), his blood pressure did not increase. Despite his state of shock, cardiac output was increased markedly and systemic vascular resistance was extraordinarily low. From his hemodynamic data (Table 1), shoshin beriberi was suspected and 100 mg of thiamin was administered intravenously, resulting in the patient's condition improving quickly (Table 1); however, peripheral blood concentration of vitamin B1, which was obtained after intravenous administration of 10 mg of thiam...

Clinical Features and Outcomes of Shoshin Beriberi

“…Previous reports have shown that 100-200 mg/day of thiamine generally improves the symptoms of Shoshin beriberi. 4,5,18) Doses of thiamine used for Shoshin beriberi in the present study were comparable to those reported in previous studies. The present study showed that alcohol-related diseases were the most common comorbidities in patients with Shoshin beriberi, followed by diabetes mellitus, depression, schizophrenia, dementia, and anorexia.…”

ST-segment Elevation of Electrocardiogram in a Patient with Shoshin Beriberi

“…Acute myocardial infarction in patients with normal coronary arteries may occur via transient occlusion of coronary vessel(s) by spasm and/or thrombus (15). Indeed, a previous case report described a case of vasospastic angina in a patient with Shoshin beriberi (16). In the present case, spasm of coronary arteries was not induced by provocation test.…”

Usefulness of central venous saturation as a predictor of thiamine deficiency in critically ill patients: a case report

“…We conducted a literature review using PubMed and Google Scholar. English language case reports published between 1990 and 2017 were reviewed using the search terms” beriberi,”” shock,” and” thiamine.” The review identified five articles describing ScvO 2 [ 4 , 9 – 12 ]. Each case described high ScvO 2 (Table 1 ).…”