s THE only heart disease attributable to A deficiency of a single dietary constituent, fully preventable and in general curable, beriberi heart disease has long fascinated clinicians. The classic descriptions of this disease as seen in the Orient and in the West were furnished by Sh~mazono [I], Aalsmeer and Wenckebach [2], Keefer [3], and by Weiss and Wilkins [4]. The high living standard, generally good if not excessive diets, and the practice of adding thiamine to food such as bread, cereals and rice, have made beriberi a relative rarity in the Western world. This disease is seen, or at least recognized, primarily in people with severe nutritional deficiency who have maintained an adequate caloric intake and have remained physically active. Thus most instances of beriberi heart disease recognized in recent years have been among chronic alcoholic patients [5-81. A number of hemodynamic studies of beriberi heart disease have been reported [5,8,9-761 but the pathophysiology of beriberi heart failure remains poorly understood. This report presents four patients with congestive heart failure attributed to beriberi, seen and studied hemodynamically, acutely and after treatment. The studies include observations on the effects of acute digitalization and of a pressor agent. As a specific biochemical test for thiamine deficiency, blood transketolase [77,78] was measured and found to be low in one of these patients.