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題名 | Shoshin Beriberi-A Fulminant High-Output Heart Failure--A Case Report=Shoshin Beriberi猛爆性高心搏輸出量心衰竭--一病例報告 |
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作者姓名(中文) | 李茂琦; 曹殿萍; 鄭景仁; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 13:4 民86.10-12 |
頁次 | 頁204-208 |
分類號 | 415.319 |
關鍵詞 | Beriberi心臟病; Beriberi heart disease; Shoshin beriberi; |
語文 | 英文(English) |
中文摘要 | 背景:Beriberi心臟病肇因於維生素B1極度缺乏,至少持續三個月。臨床上常 可見水腫,全身倦怠,疲勞,周邊性神經病變。在Shoshin beriberi所謂的猛爆 狀況下會極度降低系統性血管阻力,增加心搏速率和心搏輸出量,提高左右心 室灌注壓力和血量。若無及時補充維生素B1,病患將死於心臟衰竭和肺水 腫。此種疾病在臺灣已是越來越少且多年未見病例報告,而猛爆型更是不常 見。 方法與結果:一位二十八歲男性大陸偷渡者,因心臟衰竭和極度低血壓從新竹 靖廬轉到本院進一步處理。心臟超音波可見高血流動態。病患住入加護病房接 受肺動脈導管血流動力學檢查,發現心搏輸出量高達每分鐘19.4公升。依據病 患病史,臨床表徵,周邊性神經病變,以及血流動力學測量發現,高度懷疑維 生素B1缺乏合併Shoshin beriberi心臟病。我們立即給予維生素B1靜脈注射 100毫克,而心搏輸出量三小時後戲劇性降低。診斷因此確定,隨後他接受維生 素B1每日口服25毫克,同時給予利尿劑和毛地黃預防低心搏輸出量心衰竭。 心臟衰竭症狀四日後得到緩解,但是周邊性神經病變在出院之前仍然持續。 結論:在一個飲食缺乏,營養不均衡,或是長期酗酒的病患身上,若出現高血 流動態和高心搏輸出量心衰竭,應考慮Shoshin beriberi心臟病,及時給予完整 檢查和維生素B1治療。 |
英文摘要 | Backaground. Beriberi heart disease results from severe thiamine (vitamine B1) deficiency persisting for at least three months. Edema, general malise, fatigue, peripheral neuropathy are common. In the fulminant form of the disease, or so-called Shoshin beriberi, systemic vascular resistance is reduced; heart rate and cardiac output increased; and with elevation of the right and left ventricular filling pressure and blood volume. he patient will die of congestive heart failure and pulmonary edema, if no thiamine supplement is administered in time. This disease is more and more rare in Taiwan, and the fulminant form of the disease is much more uncommon. It has not been diagnosed on the Island for many years. Methods and Results. A 28-year-old Chinese male was transferred to our hospital from Jinn-Lu in Hsinchu for congestive heart failure and marked hypotension. Echocardiogram showed hyperdynamic heart. He was admitted to the ICU and expand underwent Swan-Ganze catheterization; the cardiac output was found to be high (19.4 L/min). According to his history. clinical manefestation, peripheral neuropathy and hemodynamic measurement, thiamine deficiency with Shoshin beriberi heart disease was highly suspected. Thiamine 100mg was supplied intravenously, and the cardiac output declined dramatically after three hours. The diagnosis was therefore confirmed. Subsequently, the patient was given thiamine 25mg daily with digoxin and lasix for preventing low output heart failure. Heart failure signs subsided four days later, but the peripheral neuropathy persisted before discharge. Conclusion. The presence of hyperdynamic and high output heart failure in a patient who has had an inadequate, unbalanced diet and/or chronic alcoholism, should raise clinical suspicion of beriberi heart disease with Shoshin beriberi and warrant full investigation and immediate thiamine treatment. |
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