Shoshin Beriberi Complicating Severe Pulmonary Hypertension: A Case Report

Transcription

1 J Cardiol 2007 Jun; 49 6 : Shoshin Beriberi Complicating Severe Pulmonary Hypertension: A Case Report Yuko Masaki Masaaki Masamichi Takakazu Jun-ichi Tetsuya Toshinari Osamu Fusako Shinsuke Seiki GOTO, MD AWATA, MD UEMATSU, MD, FJCC YANO, MD MOROZUMI, MD KOTANI, MD WATANABE, MD ONISHI, MD IIDA, MD SERA, MD NANTO, MD, FJCC NAGATA, MD, FJCC Abstract A 44-year-old male was admitted to our hospital for dyspnea, associated with severe pulmonary hypertension. The patient fell into a shock state on the next day. Hemodynamic measurements revealed high output heart failure with low peripheral vascular resistance. We suspected shoshin beriberi, a fulminant form of cardiac beriberi, by ruling out other common causes of pulmonary hypertension. The rapid recovery after intravenous thiamine administration and the patient s history of improper diet strongly supported the diagnosis. The present case of shoshin beriberi complicating severe pulmonary hypertension shows that history taking is important in elucidating the etiology and selecting the correct treatment. J Cardiol 2007 Jun ; 49 6 : Key Words Complications shoshin beriberihypertension, pulmonary Heart failure high-outputdrug therapy thiamine : : Cardiovascular Division, Kansai Rosai Hospital, Hyogo Address for correspondence: GOTO Y, MD, Cardiovascular Division, Kansai Rosai Hospital, Inabaso , Amagasaki, Hyogo ; yugotou-ham@umin.ac.jp Manuscript received December 15, 2006; revised March 1, 2007 ; accepted March 8,

2 362 :20 30 : 1 1 : : 175cm90 kg113/60mmhg 96/min 22 /min Erb Levine : ; WBC 7 100/ l RBC / l Hb 15.6 g/dl Ht 46.1% Plt / l ; T-Bil 2.5 mg/dl AST 27 IU/l ALT 20 IU/l ALP 188 IU/l-GTP 21 U/l LDH 319 IU/l TP 7.6 mg/dl Alb 4.3mg/dl TC 170 mg/dl TG 67mg/dl CPK 21 IU/l Na 136 meql/l Cl 96mEq/l K 3.7mEq/l BUN 35.7mg/dl Cr 1.85mg/dl CRP 0.4 mg/dl BS 98mg/dl HbA 1c 5.2% Lactate 5.0 meq/l TSH 1.70 U/ml FT pg/ml FT ng/dl O 2 4 l PaO mmhg PCO mmHg ph 7.46 B.E. 3.2 mmol/l HCO mmol/l Sat 94.9%; PT 17.1 sec APTT sec TAT 6.9 g/l D 4.96 g/ml FDP 7.8 g/ml BUN/Cr : 1 4 T 5 6 TFig. 1 Fig. 1 Electrocardiogram on admission Electrocardiogram showed low voltage of limb leads and non-specific ST-T abnormalities. X : 61% computed tomography : CT : :M 76% Fig. 2 Teichholz 3.4 l/min/m 2 70mmHg : FDP D TAT CT X CT J Cardiol 2007 Jun; 49 6 :

3 363 Fig. 2 Echocardiograms before and after thiamine administration Echocardiograms from the parasternal short-axis approach on admission left and 14 days after admission right. Enlarged right ventricle and interventricular septum shift to left ventricle were observed on admission left, whereas the right ventricle showed tendency to recovery and interventricular septum shift was normalized after thiamine administration right. RV right ventricle; LV left ventricle l/min PaO 2 60mmHg 70 mmhg Swan-Ganz 6 g/kg/min 84/55 mmhg 70/38mmHg16 mmhg 6.5 l/min/m dyn sec mm 2 /cm dyn sec mm 2 /cm 5 F 200 mg 3 Fig. 3 Swan-Ganz 3.7 l/min/m 2 1,643 dyn sec mm 2 /cm dyn sec mm 2 /cm mmHg Fig T 5 6 T ng/ml ng/ml ng/ml ng/ml J Cardiol 2007 Jun; 49 6 :

4 364 Fig. 3 Time course of blood pressure, pulmonary arterial pressure and serum thiamine levels before and after intravenous administration of fulsultiamine Open arrow indicates intravenous fulsultiamine administration. Swan- Ganz Wakabayashi 4 Wernicke Okura 5 J Cardiol 2007 Jun; 49 6 :

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