OVERVIEW
Pediculopathic heart disease is a high-volume heart disease caused by a severe and prolonged deficiency of vitamin B1 (thiamine). If the neurologic manifestations are predominant, it is called dry pediculosis, and if heart failure is predominant, it is called wet pediculosis. The disease is currently rare. The former manifests as ascending symmetrical peripheral neuritis, sensory and motor deficits, decreased muscle strength, foot drop and toe drop in some cases, and a cross-threshold gait when walking. The latter manifests as weakness, fatigue, palpitation and shortness of breath.
Etiology
Vitamin B1 deficiency is the cause of podiatry heart disease, commonly found in: ① long-term consumption of refined white rice or rice washing and steaming improper people; ② chronic gastroenteritis malabsorption people; ③ long-term nutritional deficiencies; ④ chronic consumptive diseases; ⑤ chronic alcoholism.
Symptoms
1. Dry foot disease
It manifests as ascending symmetrical peripheral neuritis, sensory and motor disorders, decreased muscle strength, muscle soreness with the gastrocnemius muscle as the most important, foot drop and toe drop occur in some cases, and cross-threshold gait is shown when walking. Among the cerebral nerves, the vagus nerve was the most seriously damaged, followed by the optic nerve and the motor nerve. In severe cases, hemorrhagic superior pachycephaly syndrome or cerebral pes planus may be seen, which manifests as nystagmus, amnesia, disorientation, ataxia, impaired consciousness, and coma. It may also coexist with Korsakoff syndrome with severe memory and orientation dysfunction.
2. Wet foot syndrome
It presents with weakness, fatigue, palpitations and shortness of breath. Anorexia, nausea, vomiting, dysuria and peripheral edema are seen in patients with right heart failure. Positive physical examination signs are mostly indicative of high venous pressure in the circulation. Pulse rate is rapid but rarely exceeds 120 beats per minute, blood pressure is low but pulse pressure differential is increased, and gunshot sounds are audible in the peripheral arteries. The relative turbid border of the heart on percussion may be normal or mildly to severely enlarged. Apical S3 gallop rhythm, mid-systolic murmur in the anterior region of the heart, wet rales at the bottom of both lungs, hepatomegaly, pleural effusion, abdominal effusion and pericardial effusion signs can be detected.
3. Acute fulminant cardio-vascular foot and neck disease
The manifestations are acute circulatory failure, shortness of breath and irritability, drop in blood pressure, severe peripheral cyanosis, rapid heart rate, obvious heart enlargement, and jugular vein raging. Patients may die of acute heart failure within hours or days.
Examination
1. Measurement of whole blood or erythrocyte transketolase activity
It is a more reliable indicator for diagnosing vitamin B1 deficiency. If the activity of this enzyme increases by 15% after the administration of thiamine diphosphate, it suggests vitamin B1 deficiency in the body.
2. Blood pyruvate and lactate concentration
Blood pyruvate level (normal value 57-125μmol/L) and lactate concentration are elevated in patients with vitamin B1 deficiency.
3. Electrocardiogram
The patient’s electrocardiogram may be normal or abnormal, showing sinus tachycardia, low voltage of QRS wave, inverted T wave, and right deviation of electrical axis. The Q-T interval is prolonged in the late stage.
4. Chest X-ray examination
Cardiac enlargement, pulmonary hemorrhage and pleural effusion are often seen.
5. Cardiac catheterization
It often shows elevated right atrial pressure, elevated pulmonary tamponade pressure, increased cardiac output, and left ventricular ejection fraction, which is normal in the early stages of the disease and decreases in the late stages. Peripheral vascular resistance decreases, circulation time shortens, and arteriovenous oxygen difference decreases.
Diagnosis.
The disease should be suspected in those who have consumed a vitamin B1-deficient diet for more than 3 months, or in those who have chronic diarrhea, alcoholism, diuretics, and dialysis patients who develop cardiac enlargement, elevated venous pressure in the circulation, and edema in the short term, with no other evidence of cardiac disease. Blood transketolase activity is decreased. Vitamin B1 supplementation results in cardiac enlargement, disappearance of edema, and an increase in blood transketolase activity, which further confirms the diagnosis of the disease.
Differential diagnosis
Differential diagnosis should be made with hyperthyroidism heart disease and anemia heart disease.
1. Hyperthyroidism heart disease
Hyperthyroidism heart disease can have many kinds of arrhythmia, especially anterior contraction, atrial fibrillation and atrial flutter. In addition, the first heart sound of hyperthyroidism is hyperactive, and goiter or nodular goiter can be detected. In this disease, the first heart sound is weakened, and there is a history of nutritional deficiency, as well as vitamin B1 test treatment and laboratory tests can be identified.
2. Anemic heart disease
Patients with anemic heart disease have a history of severe anemia and laboratory changes of severe anemia, and the clinical manifestations can be relieved after correcting the anemia. In addition, patients with anemic heart disease have enhanced first and second heart sounds, which can help to identify this disease.
Treatment
In addition to improving dietary nutrition, oral vitamin B1 is recommended for vitamin B1 deficiency, along with therapeutic doses of niacin, vitamin B2, vitamin B6, and vitamin B12. intramuscular injections of vitamin B1 should be given for 7 to 10 consecutive days for wet pediculosis, and then changed to oral intake. The heart rapidly shrinks, blood pressure returns, heart rate slows, and urine output increases after vitamin B1 treatment in wet foot disease.