A Case report of Cardiac Beriberi: A Commonly Misdiagnosed Disease

Abstract

Thiamine deficiency, or beriberi, is relatively rare in countries like Somalia, where alcohol consumption is uncommon and is usually related to alcohol abuse and chronic illnesses such as cancer. Despite that fact, it is necessary to ask the patients about their bad habits to unmask the etiology of the disease. A 30-year-old male who had been abusing alcohol and smoking heavily for the last six years presented with lower extremity edema, fatigue on exertion, and heart palpitations within a month. Previously there was no known chronic disease and immunosuppression drugs use, nor any documented family history of any heart disease. Upon inspection, He had a chronically ill-looking appearance but was oriented to time, place, and person. His vital signs were a blood pressure of 115/80 mm Hg, heart rate of 110 beats/min, and body temperature of 36.5℃. Peripheral oxygen saturation was around 97% without oxygen support, despite having subjective dyspneic symptoms. Transthoracic echocardiography showed LV global hypokinesia with severe reduction in LV systolic function (as demonstrated by an LV ejection fraction of 30%). Empirical oral Thiamine 200mg replacement was initiated emergently as a thiamine test was not available. Within ten days of thiamin supplement and heart failure medications, including furosemide 20mg, Aldactone 25mg, and carvedilol 6.25mg, the ejection fraction improved up to 45% also, the fatigues and dyspnea were also highly improved. We identified that heavy alcoholic drinking induced heart failure with reduced ejection fraction and that thiamine supplements improved these circumstances.