Hemodynamics in Beriberi Heart Disease as Observed in A Typical Non-Alcoholic Case

Abstract

A 15-year-old boy was admitted to the Nippon Medical School Hospital with complaints of palpitation, shortness of breath, and slight swelling of lower extremities with numbness. On admission, diminished deep tendon reflexes and distended neck veins were noted. Blood pressure was 120/0 mmHg. A grade III/VI systolic ejection murmur and the third and fourth sounds at the apex were audible. Ordinary laboratory data were almost within normal limits. ECG showed ventricular extrasystoles and marked PR prolongation with transient Wenckebach's period. Venous pressure was 260 mmH2O and cardiothoracic ratio 46%. The whole blood vitamin B1 level, urinary excretion level and erythrocyte transketolaseactivity were 1.9 μg/dl, 14.3 μg/day, and 325 μg/ml/hr, respectively, while the thiamine diphosphate effect was 48.3%. From these findings a diagnosis of purely dietary beriberi disease was made. Bilateral cardiac catheterization revealed elevation of left and right ventricular end-diastolic pressures, mean pulmonary artery pressure and pulmonary wedge pressure to 23.5, 15.0, 20.5 and 13.5 mmHg, respectively. Cardiac output was increased to 181/min and stroke volume to 198 ml/beat. Total systemic vascular resistance had fallen to 784 dyne.sec.cm-5. Heart muscle biopsy revealed edema in the myocardium and the interstitial space. After 14 days on an ordinary diet, the patient's subjective complaints as well as his biochemical and hemodynamic data were almost completely improved.