BERIBERI HEART DISEASE IS CAUSED BY SEVERE thiamine deficiency. This disease is most prevalent in the Far East, however, in the past decade its prevalence has markedly decreased. It occurs mainly in individuals whose staple diet consists of polished rice that is deficient in thiamine but high in carbohydrates. Diets with a high carbohydrate content require a greater intake of thiamine. White bread enriched with thiamine has helped in this respect. Because alcohol is high in carbohydrate content but deficient in thiamine, some alcoholics become thiamine deficient and weakness of the heart muscle may occur. The disease is also common in fad dieters.

CLINICAL MANIFESTATIONS

Swelling of both legs is caused by edema and may become severe. Pitting edema of both legs may extend up to the thighs and over the trunk. The heart becomes dilated and weakness of the muscle progresses to heart failure. Beriberi heart disease may cause sudden cardiac dysfunction within
days of onset of symptoms. This condition is accompanied by low blood pressure, tachycardia, and lactic acidosis. Patients may die within hours or within days of cardiogenic shock and pulmonary edema. On laboratory diagnosis for Beriberi heart disease serum pyruvate and lactic acid levels are increased. The ECG shows low-voltage QRS complex and prolongation of the QT interval. Chest x-ray usually shows dilatation of both ventricles and congestion of the lungs with pleural effusions.

Treatment including administration of 100 mg of IV thiamine, then 25 mg daily for about 2 weeks causes dramatic improvement. Although the initial treatment does not require digoxin and diuretics, a few days after starting thiamine therapy digoxin and diuretics are indicated and produce beneficial results. Disturbance of nerves in the legs often accompanies the heart symptoms and thiamine replacement improves this type of polyneuropathy.