Most common cause of cardiomegaly without significant murmur in pediatric age group at tertiary care hospital, Hyderabad, India: a prospective observational study

Chandra Mohan Chekkali, Rakesh Kotha, Himabindu Singh, Narahari Bapanpalli, Sadiqua Anjum, Alimelu ., Arjun Jadhao


Background: Following the invention of monaural stethoscope by Laennec and X ray by Roentgen in 18th century there was spectacular advancements in cardiology. The myocardium can be affected by various disease process unrelated to abnormal pressure or volume loads. These processes may be inflammatory, metabolic, infiltrative, ischemic or primary with significant overlap. These diseases usually present as cardiomegaly. In pediatric age group cardiac diseases will present early, sometimes without any signs and symptoms like sudden death due to less cardiac reserve. Few cases of sudden death also showed huge cardiomegaly in postmortem X rays. authors want to carry out this study to find out most common cause of cardiomegaly with silent chest as authors usually miss the diagnosis and these cases may present as sudden death without giving much time to intervene. The aim of the study is to know the most common cause of cardiomegaly without significant murmur in pediatric age group above one year.

Methods: Prospective observational study done at a tertiary care hospital Hyderabad over a period of one year from January 2018 to January2019.

Results: Most common cause of cardiomegaly without significant murmur was cardiac beriberi. It is mostly prevalent in rural areas of Telangana, mostly occurring in breastfed babies and below six years. All cases were recovered after proper treatment. Fortunately, it is associated with nil mortality, if timely treatment was initiated.

Conclusions: Cardiac beriberi which is easily preventable and if treated in proper time it will associated with nil mortality. As it was occurring commonly breastfed babies supplementation of Thiamine to mothers was very useful as a preventive strategy.


Beriberi, Cardiomegaly, Myocardium, Pediatrics, Thiamine

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Alvarez JA, Orav EJ, Wilkinson JD, Fleming LE, Lee DJ, Sleeper LA, et al. Competing risks for death and cardiac transplantation in children with dilated cardiomyopathy: results from the pediatric cardiomyopathy registry. Circulation. 2011;124(7):814-23.

Raphael MJ. Cardiac enlargement. In: Grainger RG, Allison JD, eds. Diagnostic Radiology. 4th ed. Great Britain: Churchill Livingstone; 1987:551-564.

Keats Theodore E. Heart size measurements: The cardiovascular system. In: Keats TE, Lusted LB, eds. Atlas of Roentenographic measurement. 5th ed. Chicago: Year Book Medical Publishers Inc; 1985:268-269.

Oladipo GS, Okoh PD, Kelly EI, Arimie COD, Leko BJ. Normal heart sizes of Nigerians within Rivers State using cardiothoracic ratio. Scientia Africana. 2012;11(2):9-21.

Braunwald E. Heart disease: A textbook of cardiovascular medicine. 6th ed. Philadelphia: Saunders; 2001:63.

Abdurrahman L, Bockoven JR, Pickoff AS, Ralston MA, Ross JE. Pediatric cardiology update: Office-based practice of pediatric cardiology for the primary care provider. Curr Probl Pediatr Adolesc Health Care. 2003;33(10):318-47.

Raphael MJ, Donaldson RM. The normal heart: methods of examination. In: Sutton D, Allan PL, eds. A Textbook of Radiology and Imaging. 4th ed. Great Britain: Churchill Livingstone; 1987:538-556.

AL Jarallah AS, AL Abdulgader AA, Saadi MM, Nasser AA, Zahraa JN. Outcome of dilated cardiomyopathy (DCM) in Saudi children: a survey over a decade. J Saudi Heart Assoc. 2008;20:1-5.

Venugopalan P, Agarwal AK, Akinbami FO, El Nour IB, Subramanyan R. Improved prognosis of heart failure due to idiopathic dilated cardiomyopathy in children. Int J Cardiol. 1998;65:125-8.

Hong YM. Cardiomyopathies in children. Korean J Pediatr. 2013;56(2):52-9.

Lipshultz SE, Sleeper LA, Towbin JA, Lowe AM, Orav EJ, Cox GF, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med. 2003;348(17):1647-55.

Batra AS, Lewis AB. Acute myocarditis. Curr Opin Pediatr. 2001;13:234-9.

Drucker NA, Newburger JW. Viral myocarditis: diagnosis and management. Adv Pediatr. 1997;44:141-71.

Soukaloun D, Kounnavong S, Pengdy B, Boupha B, Durondej S, Olness K, et al. Dietary and socio-economic factors associated with beriberi in breastfed Lao infants. Ann Trop Paediatr. 2003;23:181-6.

WHO. Thiamine deficiency and its prevention and control in major emergencies. 1999.

Naidoo DP. Beriberi heart disease in Durban: a retrospective analysis. S Afr Med J. 1987;72:283-5.

Davis RA, Wolf A. Infantile beriberi associated with Wernicke's encephalopathy. Pediatrics. 1958;21:409-20.

Keating EM, Nget P, Kea S, Kuong S, Daly L, Phearom S, et al. Thiamine deficiency in tachypnoeic Cambodian infants. Paediatr Int Child Health. 2015;35(4):312-8.

Mimouni-Bloch A, Goldberg-Stern H, Strausberg R, Brezner A, Heyman E, Inbar D, et al. Thiamine deficiency in infancy: long-term follow-up. Pediatr Neurol. 2014;51:311-6.