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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014
AFRICA
e5
depletion. Therefore, activation of ATP-sensitive potassium
channels by ATP depletion induced by thiamine deficiency may
contribute to ST-segment elevation in severe beriberi.
Thiamine deficiency is rare in developed countries and is
most commonly associated with chronic alcohol abuse. Other
predisposing conditions include chronic dietary malnutrition
and impaired absorption or intake of dietary nutrients.
12
In the present case, thiamine deficiency resulted from TPN
administration without thiamine supplementation. Because the
capacity of thiamine storage in the body is small and the half-
life of thiamine is only 10 to 18 days, patients depending on
TPN become deficient in thiamine within a few weeks without
thiamine supplementation.
Cardiac beriberi, including shoshin beriberi, is well reported
in the literature. Shoshin beriberi, if not timeously recognised
and promptly treated, can result in rapid haemodynamic collapse
and death. However this condition is often under-recognised in
clinical practice because of its rarity. In this setting, the diagnosis
of shoshin beriberi requires a high index of clinical suspicion,
particularly in groups with a high risk of thiamine deficiency.
When in doubt, thiamine should empirically be given because
toxicity is not likely. Administration of thiamine is not only
a simple and inexpensive treatment that can rapidly reverse a
potentially lethal condition, but also a confirmative diagnostic
technique. In the present case, thiamine administration
dramatically improved the patient’s haemodynamic status and
saved his life.
Conclusion
Although thiamine deficiency is now relatively infrequent in
developed countries, clinician should take into account cardiac
beriberi (or shoshin beriberi) as one of the differential diagnoses
in patients with heart failure or cardiogenic shock.
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