A case of ST-elevation and nystagmus—when coronary thrombosis is not to blame

• Published in: QJM : An International Journal of Medicine Vol. 102; no. 10; pp. 737 - 739
• Main Authors: Daly, M.J., Dixon, L.J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2009
• Subjects: Arrhythmias, Cardiac - etiology; Beriberi - complications; Beriberi - diagnosis; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Coronary Thrombosis - diagnosis; Diagnosis, Differential; Electrocardiography; Female; General aspects; Heart; Humans; Long QT Syndrome - etiology; Medical sciences; Middle Aged; Nystagmus, Pathologic - etiology; Oculomotor disorders; Ophthalmology; Vascular disease; Medicine; ST elevation; Eye disease; Coronary artery; Nystagmus; Cardiovascular disease; Oculomotor syndrome; Coronary heart disease; Thrombosis
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcp095

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.