The Heart Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
QJM. 2009 Oct;102(10):737-9. doi: 10.1093/qjmed/hcp095. Epub 2009 Jul 21.
We present the case of a post-menopausal female who, following a prolonged period of vomiting and diarrhoea, presented acutely with Wernicke's; encephalopathy, chest pain, ST-segment elevation and congestive cardiac failure associated with hypotension. Coronary angiography demonstrated no abnormality. Haemodynamics improved significantly in the short-term following intravenous thiamine replacement, with complete resolution of all ST-segment abnormalities and normalization of left ventricular function at six-week follow-up. Shoshin beriberi in the context of metabolic alkalosis, secondary to severe electrolyte depletion, is exceptional and is a differential diagnosis to be considered in all malnourished patients presenting with symptoms and signs suggestive of an acute coronary syndrome, especially those with a history of alcohol-dependence.
我们报告了一例绝经后女性的病例，她在长时间呕吐和腹泻后，突然出现 Wernicke 脑病，伴有胸痛、ST 段抬高和与低血压相关的充血性心力衰竭。冠状动脉造影未发现异常。静脉补充硫胺素后，血液动力学在短期内显著改善，所有 ST 段异常完全缓解，左心室功能在 6 周随访时恢复正常。严重电解质缺乏继发代谢性碱中毒导致的 Shoshin 脚气病非常罕见，是所有有营养不良、出现急性冠状动脉综合征症状和体征的患者（特别是有酒精依赖史的患者）的鉴别诊断之一。
