Idiopathic heart disease: I. Analysis of 100 cases, with special reference to chronic alcoholism

Abstract

Clinical, laboratory, roentgenographic, hemodynamic and autopsy data have been assembled in 100 cases of heart disease of obscure etiology in a large veterans hospital. These cases contributed 2.4 per cent of all heart disease. Eightythree per cent were chronic alcoholics; seventeen patients were discharged with a diagnosis of beriberi heart disease (group 1) and sixty-six (group 2) with a diagnosis of alcoholic heart disease or its equivalent. In these two groups 50 and 65 per cent of the subjects, respectively, drank beer and/or wine exclusively compared to 19 per cent of a control alcoholic group (group 3) without heart disease (p < 0.01). The diagnosis, which is usually made by excluding more common causes of disease, is often missed. Helpful clues to improve accuracy in diagnosis have been emphasized. The relationship of alcoholic heart disease to beriberi is discussed. Evidence, although inconclusive, suggests that they may be phases of the same underlying disease resulting from alcoholism and malnutrition. In this view beriberi would be considered an early phase of the disease with high cardiac output due to shunting in the periphery which in most cases can be restored to normal without thiamine. As the disease progresses to the advanced state, irreversible cardiomegaly, intractable low output heart failure and increased peripheral vascular resistance dominate the clinical picture. Before this hypothesis can be accepted, however, documentation of hemodynamic and clinical data of cases progressing from early to late stages must be presented.