Abstract
Background: Cardiac acute beriberi (Shoshin syndrome) is a rare disease that may lead
to a fatal outcome if not treated specifically. Objectives: We report a case of Shoshin
syndrome with an unusual presentation of cardiogenic shock and an electrocardiographic
pattern of severe myocardial ischemia suggesting left main coronary artery obstruction.
Case Report: A 35-year-old man presented with chest discomfort, diffuse ST-segment
depression in the 12-lead electrocardiogram (ECG) with ST-segment elevation in aVR,
and rapidly evolving congestive heart failure leading to cardiogenic shock. Intensive
support was required, including mechanical ventilation, high doses of inotropics and
vasopressors, intra-aortic balloon counterpulsation, and continuous renal replacement
therapy. An emergency coronary angiogram was performed that showed normal coronary
arteries. Right heart catheterization showed a high-output state with elevated filling
pressures suggesting high-output heart failure. The echocardiography confirmed normal
left and right ventricular contraction. Thiamine deficiency was suspected as the cause
of the high-output heart failure. After a single dose of intravenous thiamine (100
mg), the patient's hemodynamic status improved dramatically within minutes, allowing
a rapid discontinuation of hemodynamic support. Subsequent ECGs showed complete resolution
of ST-segment abnormalities. Serial lactate measurements, red blood cell transketolase
activity, and the thiamine pyrophosphate response test were concordant with a thiamine
deficiency state. Conclusion: Shoshin syndrome may present as cardiogenic shock with
an ECG mimicking severe myocardial ischemia, and if suspected, can be rapidly and
effectively treated.
Keywords
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Article info
Publication history
Published online: October 20, 2008
Accepted:
March 17,
2008
Received in revised form:
January 18,
2008
Received:
November 5,
2007
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
