Beriberi heart disease in two thai laborers working in Saudi Arabia: recovery from shoshin beriberi

ABSTRACT

More than 200 cases of unexplained sudden death, in apparently healthy Thai workers, have been reported in the Far East during the last year. Described herein are two patients with beriberi heart disease. Both patients presented with a recent history of dyspnea, ankle edema, tachycardia and with physical signs of biventricular heart and clinical features of high cardiac output failure. The diet regimen was low in thiamine and both patients ate polished rice three times a day. Echocardiographic and Doppler studies revealed, in both cases, a left ventricle with a normal size and ejection fraction. The right atrium and ventricle were dilated. Despite conventional anti-failure therapy with digoxin, diuretics, and eventually intravenous inotropic support, one of the patients developed severe cardiogenic shock and metabolic acidosis. There was a dramatic hemodynamic response to intravenous thiamine and the patient recovered within hours. In both cases, the clinical features of high cardiac output status with biventricular heart failure subsided with thiamine therapy. These findings were corroborated by the normalization of the heart size and cardiac output in both cases