title: Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum.
abstract: 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 cardiomegaly. 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 and both showed a spectacular improvement of congestive heart failure symptoms after treatment with thiamine. A therapeutic trial with thiamine is the only way to rapid diagnosis.
authors.affiliation: Department of Cardiology K.U. Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Shivalkar
authors.forename: I
authors.initials: I
authors.lastname: Engelmann
authors.forename: L
authors.initials: L
authors.lastname: Carp
authors.forename: H
authors.initials: H
authors.lastname: De Raedt
authors.forename: R
authors.initials: R
authors.lastname: Daelemans
mesh_terms: D000328:Adult; D001602:Beriberi / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002302:Cardiac Output; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D013831:Thiamine / Q000627:therapeutic use
chemical_list: D013831:Thiamine