Thiamine deficiency can have cardiovascular and neurological manifestations
. Cardiac beriberi is classically thought to represent a high-output state
with oliguria and lactic acidosis. The condition can, however, also present
itself with a low cardiac output and fulminant vascular collapse, or as an
acute fatal form, causing sudden death, without clear-cut signs of cardiom
egaly. In the western society beriberi is mainly encountered in alcoholics.
We report on two cases, one with high-output failure and the other with low
-output failure and cardiovascular collapse. In both patients the diagnosis
of shoshin syndrome was made, and both showed a spectacular improvement of
congestive heart failure symptoms after treatment with thiamine. A therape
utic trial with thiamine is the only way to rapid diagnosis.