Reappearance of beriberi heart disease in Japan

From the Third Division, Department of Internal Medicine, Faculty of Medicine, Kyoto University. This study was supported, in part, by Grant for Cardiomyopathy from the Ministry of Health and Welfare and Grant 357308, 1978, from the Ministry of Education, Japan. Part of this study was presented at the Symposium on “Secondary Myocardial Disease” of the 44th Scientific Session of the Japanese Circulation Society, Tokyo, 1979. Requests for reprints should be addressed to Dr. Chuichi Kawai, 3rd Division, Department of Internal Medicine, Kyoto University Hospital, 53 Kawaracho Shogoin. Sakyoku, Kyoto 606, Japan. Manuscript accepted March 31,198O. * Present address: Department of Cardiology, Tenri Hospital, 200 Mishimacho, Tenri City, Japan. Twenty-three Japanese patients with beriberi heart disease, 17 of them teenagers, were studied. The recent tendency for teenagers to take excessive sweet carbonated soft drinks, instant noodles and powermill-polished rice readily induces relative thiamine deficiency. A sudden increase in thiamine requirements due to strenuous exercise can result in overt beriberi heart disease. Alcohol had nothing to do with the development of the disease. Characteristic features commonly seen in teenage patients include peripheral edema, low peripheral vascular resistance, increased venous pressure, enlarged heart, T wave abnormalities, hyperkinetic circulatory state and increased circulating blood volume. Thiamine deficiency was confirmed by a decrease in blood thiamine concentration, a decrease in erythrocyte transketolase activity and an increase in thiamine pyrophosphate (TPP) effect. Improvement was rapidly achieved with thiamine administration, balanced nutrition and rest, especially in the teenage patients. Increased circulating blood volume was useful in differentiating beriberi heart disease from hyperthyroidism.