Thiamine deficiency can cause high-output cardiac failure (wet beriberi) or neurologic symptoms (dry beriberi). In North America, thiamine deficiency occurs in alcoholics or those with chronic disease. In alcoholics, deficiency is secondary to low intake, impaired absorption and storage, and accelerated destruction. Genetic factors are important as clinical manifestations occur only in a small proportion of chronically malnourished individuals. Beriberi heart disease is characterized by peripheral vasodilatation, sodium and water retention, and high-output CHF.