NUTRITIONAL HEART DISEASE

Abstract

The prevailing concept of beri-beri heart disease is based on the syndrome described by Alsmeer and Wenckebach (Wenckebach, 1928, 1932, 1934; Alsmeer and Wenckebach, 1929). It was heart failure characterized by sinus rhythm, systemic venous engorgement, peripheral cedema, and signs of a fast circulation such as bounding pulses and pistol-shot sounds over the major arteries. They emphasized that the failure was exclusively of the right heart. The electrocardiogram was normal except for a " certain degree of preponderance of the right ventricle." Enlargement of the heart was progressive, but whereas in the earliest phase of the disease this involved the whole heart, subsequent enlargement chiefly affected the right side. Histologically, the salient lesion was " hydropic " degeneration of the myocardium. Wenckebach attributed the whole syndrome to water retention. He regarded the functional defect of the myocardium as one of contractility, conduction being unimpaired. The disease was endemic in the Dutch East Indies.