Beriberi heart disease
Introduction
Introduction to beriberi heart disease Aberrant heart disease (beriberiheartdisease) is a high-displacement type of heart disease caused by severe and long-term deficiency of vitamin B1 (thiamine). The peripheral arterial resistance is reduced and the cardiac output is increased. basic knowledge Sickness ratio: 0.0004% Susceptible people: no special people Mode of infection: non-infectious Complications: congestive heart failure cardiogenic shock
Cause
The etiology of beriberi heart disease
(1) Causes of the disease
Vitamin B1 deficiency is the cause of athlete's foot heart disease, which is common in: 1 long-term consumption of white rice or rice steamed improperly; 2 chronic gastroenteritis malabsorption; 3 long-term nutritional deficiency; 4 chronic wasting disease; 5 chronic Alcoholism.
(two) pathogenesis
1. Pathogenesis After the conversion of vitamin B1 to TPP, as a coenzyme involved in pyruvate dehydrogenation and -ketoglutarate oxidative decarboxylation process, vitamin B1 deficiency reduces the conversion of pyruvate to acetyl-CoA, reducing the conversion of -ketoglutarate to Succinic acid CoA, which ultimately damages the oxidative phosphorylation process of sugar, reduces the production of high-energy phosphate, resulting in insufficient energy supply to the nervous system and myocardium.
The mechanism of wet beriberi manifested as high cardiac output heart failure is not clear, and may be related to sympathetic damage and blood pyruvate, increased lactic acid content leading to peripheral arterial dilatation, peripheral vascular resistance decreased, blood circulation accelerated, and blood flow back Increase, increase cardiac output, at the same time, leading to increased arteriovenous shunt, arteriovenous blood oxygen difference.
2. Pathological vitamin B1 deficiency often and nervous system and cardiovascular system: mainly neurological diseases, no congestive heart failure called dry beriberi; cardiovascular disease, congestive heart failure For wet beriberi, dry beriberi invades the peripheral nerves, is non-inflammatory myelin degeneration, severely invades the upper midbrain, gray matter around the midbrain aqueduct, lower thalamus, third ventricle, fourth ventricle and cerebellum, manifested as Vasodilatation, vascular proliferation, perivascular hemorrhage, brain cell necrosis and gliosis, pathological changes in wet beriberi are non-specific changes, autopsy shows cardiac hypertrophy, myocardial cells and conduction system are degenerative, edema and necrosis, A large number of lymphocytes infiltrated, myocardial interstitial edema was obvious, double ventricular expansion and hypertrophy, mainly due to right ventricular involvement.
Prevention
Alveolar heart disease prevention
1. Eat more brown rice, or add thiamine to rice.
2. Avoid excessive intake of carbonated beverages, and should not engage in vigorous activities during the summer.
3. Avoid long-term use of diuretic treatment.
4. Treat thiamine-containing foods such as crabs and fish by baking or boiling.
Complication
Beribillary heart disease complications Complications, congestive heart failure, cardiogenic shock
Concomitant congestive heart failure, cardiogenic shock, etc., but less common.
Symptom
Athlete's foot disease symptoms Common symptoms Ataxia muscle soreness Nausea diarrhea
1. Dry beriberi manifests as ascending symmetry peripheral neuritis, sensory and dyskinesia, decreased muscle strength, muscle soreness, especially gastrocnemius, and some cases have foot and sag, and cross-threshold steps when walking The vagus nerve is most severely damaged in the cranial nerves, followed by the optic nerve, the oculomotor nerve, the augmentation nerve and the vestibular cochlear nerve. In severe cases, hemorrhagic upper polio syndrome or cerebral beriberi (Wernicke encephalopathy) can be seen as an eyeball. Tremors, forgetfulness, disorientation, ataxia, insanity, disturbance of consciousness, paralysis and coma can also coexist with Korsakoff syndrome, with severe memory and directional dysfunction.
2. Wet beriberi is characterized by weakness, fatigue, palpitations, and shortness of breath. Patients with right heart failure and water-sodium retention have anorexia, nausea, vomiting, oliguria and peripheral edema. The positive signs of physical examination are mostly manifestations of systemic venous pressure. The pulse rate is fast but rarely exceeds 120 beats/min. The pulse beat is obvious, the blood pressure is low, but the pulse pressure difference is increased. The surrounding arteries can smell the gunshot sound. The percussion heart can be normal, or light to severe enlargement, apical S3 Running horse, the anterior systolic murmur in the anterior region of the heart, the wet sounds of the two lungs, can be found in the liver, pleural effusion, ascites and pericardial fluid signs.
3. Acute fulminant cardiovascular vascular beriberi (Shoshin beriberi) manifested as acute circulatory failure, shortness of breath, irritability, decreased blood pressure, severe peripheral cyanosis, rapid heart rate, obvious heart enlargement, jugular vein engorgement, mild or Without peripheral edema, the patient can die of acute heart failure within hours or days.
Examine
Examination of beriberi heart disease
1. Determination of whole blood or erythrocyte transketolase activity is a reliable indicator for the diagnosis of vitamin B1 deficiency. If the activity of the enzyme is increased by 15% after administration of thiamine diphosphate, it indicates a deficiency of vitamin B1 in the body.
2. The blood pyruvate content (normal value 57 ~ 125mol / L) and the increase of lactic acid concentration in patients with vitamin B1 deficiency.
3. ECG examination of the patient's ECG can be normal or abnormal, but no specific changes, manifested as sinus tachycardia, QRS wave low voltage, T wave inversion, electrical axis right deviation, late QT interval prolongation.
4. Chest X-ray examination often shows heart enlargement, pulmonary congestion and pleural effusion.
5. Cardiac catheterization often shows elevated right atrial pressure, increased lung incarceration pressure, increased cardiac output, left ventricular ejection fraction normal in the early stage of the disease, decreased in the late stage of the disease, decreased peripheral vascular resistance, and reduced cycle time. The arteriovenous oxygen difference is reduced.
Diagnosis
Diagnosis of beriberi heart disease
Diagnostic criteria
Ingestion of vitamin B1 deficiency for more than 3 months, or long-term diarrhea, alcoholism, taking diuretics and dialysis patients, short-term heart enlargement, increased systemic venous pressure, edema, no other evidence of heart disease should be suspected and the disease It can be accompanied by or without peripheral neuritis and pellagra, blood transketolase activity decreases, the heart shrinks after vitamin B1 supplementation, edema disappears, and blood transketolase activity increases, which further confirms the disease.
Differential diagnosis
To be differentiated from hyperthyroidism, anemia, and so on.
1. Thyroid hyperthyroidism Excessive thyroid hormone directly and/or indirectly acts on the myocardium and peripheral vascular system, causing the heart to be in a state of high blood output, causing hyperthyroidism, leading to cardiac insufficiency, and The disease is quite similar, but hyperthyroidism can have multiple arrhythmias, especially pre-contraction, atrial fibrillation and atrial flutter are more common. In addition, hyperthyroidism is the first heart sound hyperthyroidism, and can cause thyroid enlargement. Or nodular goiter, and the first heart sound of the disease is weakened, and there is a history of nutritional deficiencies and vitamin B1 test treatment and laboratory tests can be identified.
2. Anemia of severe heart disease and prolonged anemia cause insufficient blood oxygen supply, accelerated heart rate compensation, reduced peripheral circulation resistance, can lead to high blood output status, need to be differentiated from the disease, but anemia patients with heart disease The laboratory has a history of severe anemia and severe anemia. After the treatment of corrected anemia, the clinical manifestations can be alleviated. In addition, the first and second heart sounds of patients with anemic heart disease are helpful for the identification of this disease.
