From the Guidelines
Thiamine deficiency can indeed affect the right ventricle, as it is essential for carbohydrate metabolism and energy production in cardiac muscle cells, including those of the right ventricle. Thiamine plays a crucial role in maintaining the proper functioning of the heart muscle. When thiamine levels are inadequate, the heart muscle's ability to function properly becomes compromised, which can lead to dysfunction, dilation, and reduced contractility of the right ventricle. According to a study published in Circulation in 2015 1, water-soluble vitamins, particularly thiamine, may be hyper-secreted with the use of loop diuretic agents, increasing the risk for deficiencies.
Some key points to consider include:
- Thiamine deficiency can lead to high-output heart failure affecting both ventricles, including the right ventricle
- The right ventricle can experience dysfunction, dilation, and reduced contractility due to thiamine deficiency
- Treatment involves immediate thiamine supplementation, typically starting with 100-300 mg intravenously for 3-5 days, followed by oral thiamine 100 mg daily until clinical improvement occurs
- Patients at risk include those with chronic alcoholism, malnutrition, prolonged vomiting, or after bariatric surgery
- Early recognition and treatment are crucial as cardiac manifestations of thiamine deficiency can be reversed if addressed promptly, but may become permanent if treatment is delayed, as supported by the principles outlined in the study 1.
It is essential to recognize the importance of thiamine in maintaining cardiac health, particularly in patients at risk of deficiency, to prevent long-term damage to the right ventricle and overall heart function.
From the FDA Drug Label
Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety It is also indicated when giving IV dextrose to individuals with marginal thiamine status to avoid precipitation of heart failure
The answer to whether thiamine deficiency can affect the right ventricle is not directly stated in the label. Thiamine deficiency is associated with cardiovascular disease, but it does not specify which ventricle is affected. Therefore, no conclusion can be drawn about the specific effect on the right ventricle 2.
From the Research
Thiamine Deficiency and Right Ventricle
- Thiamine deficiency can affect the right ventricle, as evidenced by several studies 3, 4, 5, 6.
- A case study published in 1987 reported a patient with beriberi presenting with severe right-sided cardiac failure, which improved with thiamine replacement 3.
- Another study from 2018 found that thiamine administration remarkably reversed hemodynamic indices in a patient with wet beriberi and multiple organ failure, including improvement in right ventricular function 4.
- Thiamine deficiency can also lead to reversible pulmonary hypertension, which can affect the right ventricle 5.
- Additionally, cardiac beriberi, a condition caused by thiamine deficiency, can present with right heart failure and pulmonary hypertension, and is often missed in clinical practice 6.
Mechanism of Thiamine Deficiency
- Thiamine deficiency can be caused by various factors, including dietary deficiency, chronic alcohol abuse, and certain medications such as furosemide 3, 4, 7.
- Furosemide therapy has been shown to cause thiamine deficiency in patients with heart failure, particularly those treated chronically with high doses 7.
- Thiamine supplementation has been found to improve left ventricular ejection fraction and functional capacity in patients with heart failure and reduced left ventricular ejection fraction who were treated with diuretics 7.