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ALCOHOLIC BERI-BERI HEART

1939; BMJ; Volume: 1; Issue: 3 Linguagem: Inglês

10.1136/hrt.1.3.187

1468-201X

A. M. Jones, Crighton Bramwell,

Hemoglobinopathies and Related Disorders

Heart failure due to vitamin deficiency has not hitherto attracted much attention in this country.A single case was reported recently by Price (1938) and another by Yudkin (1938).The case that follows illustrates certain features characteristic of the condition. CASE REPORTA man, aged 36, was admitted to the Manchester Royal Infirmary on November 11, 1938, with acute heart failure.The distribution of the cedema was unusual and, in certain respects, resembled that of renal rather than that of cardiac insufficiency.The face was puffy, the eyelids swollen ; there was massive cedema of the legs extending to the thighs; the penis and scrotum were enormously swollen ; the abdomen was distended and contained free fluid; moist sounds were present in the lungs ; there was slight engorgement of the veins of the neck and the liver was palpable.Swelling of the ankles, which was greatest in the morning and diminished towards evening, had first been noticed only two weeks previously, and short- ness of breath on exertion had been present for only ten days.Three months prior to admission the patient had felt perfectly fit, but his friends had remarked on the fact that he had required to pass water surprisingly seldom, considering the large quantities of beer he drank.The other prominent symptoms were anorexia and epigastric pain.These will be referred to later.On examination of the circulatory system, the heart was found to be greatly enlarged (Fig. 1), the maximal cardiac impulse being situated in the fifth space 4 cm.beyond the mid-clavicular line.On auscultation, there was typical presystolic gallop rhythm with a loud apical systolic murmur.The resting pulse rate was 120 and the rhythm regular.The blood pressure was 160/90 mm. ; but the diastolic endpoint was poorly defined, the sounds gradually diminishing in intensity and a systolic bruit being heard down to a decom- pressing pressure of 30 mm.The knee-jerks could be elicited only on reinforcement and the ankle-jerks were absent.There was no sensory loss to pain, light touch, vibration sense, p