Keshan disease

Keshan disease
Classification and external resources
Specialty endocrinology
ICD-10 E59
ICD-9-CM 269.3
DiseasesDB 11941

Keshan disease is a congestive cardiomyopathy caused by a combination of dietary deficiency of selenium and the presence of a mutated strain of Coxsackievirus, named after Keshan County of Heilongjiang province, Northeast China, where symptoms were first noted. These symptoms were later found prevalent in a wide belt extending from northeast to southwest China, all due to selenium-deficient soil. The disease peaked in 1960–1970, claiming thousands of lives.[1][2]

Often fatal, the disease afflicts children and women of child bearing age, characterized by heart failure and pulmonary edema. Over decades, supplementation with selenium reduced this affliction.[3]

It had been linked to the coxsackie B virus. Current research suggests that the lack of selenium results in a more virulent strain of the coxsackievirus becoming the dominant viral species present in the population of virus, but the mechanism of this selection event is unclear.[4][5]

The disease got its name from the province in which it was discovered: Keshan, China. Since its discovery, it can also be found in New Zealand and Finland. Keshan disease results from a selenium deficiency which is a nutrient we receive in our diet from eating foods that were grown in selenium enriched soils. Because of that factor, Keshan deficiency can be found anywhere that the level of selenium present in the soil is low. An individual with Keshan disease will have an abnormally large heart. Keshan disease can also lead to higher rates of cancer, cardiovascular disease, hypertension, and strokes. In addition, an individual can experience eczema, psoriasis, arthritis, cataracts, alcoholism, and infections.


It is hard to consider Keshan disease extremely preventable because the only way to ensure that the individual is getting enough selenium would be to test the soil in the area. However, one way that selenium intake can be improved is to increase intake of foods that have been enriched with selenium. Examples include onions, canned tuna, beef, cod, turkey, chicken breast, enriched pasta, egg, cottage cheese, oatmeal, white or brown rice, and garlic. If the individual lives in an area that does not have selenium enriched soil, dietary supplementation should be considered. To determine whether or not an individual is selenium deficient, blood testing is performed.


The treatment for Keshan disease is selenium supplementation. The recommended amounts are fifty-five micrograms of selenium per day for adult men and women, sixty micrograms a day for women during pregnancy and seventy micrograms per day for women after pregnancy. A doctor may insist that if a man is sexually active, he may have to take up to seventy micrograms of selenium per day. A doctor may also recommend that the individual take Vitamin E; selenium and Vitamin E are medically linked and seem to work to together. An individual will also be advised to have a diet that includes seafood, meats such as kidney, and liver, and some grains and seeds; all of these are high in selenium. Brewer’s yeast and wheat germ both contain high levels of selenium. Garlic, onions, mushroom, broccoli, tomatoes, radishes, and Swiss chard may be good sources of selenium if the soil in which they are grown contains it. An individual will have to be monitored once they begin to take the selenium supplements, due to the fact that too much of it can cause balding, intestinal distress, weakness, and slow mental functioning. Individuals in China with the disease treat it with a herb called Astragalus, which accumulates selenium from the soil.[6]

Living with Keshan disease

The individual should consult doctor if their symptoms worsen to prevent any major complications of the condition.

Avoid alcohol—avoid alcohol consumption during the duration of the illness, because alcohol may increase stress on the already-strained heart and can make symptoms worse.

Increase consumption of foods rich in selenium—eat foods rich in selenium to help the individuals heart heal more quickly (in addition to any supplements they may also be taking).

Monitor side effects to medications—if the patient is prescribed medication, it may be helpful if they can monitor any side effects they have (if they are present) and see their doctor if the side effects are more than just the mildly common ones.

Increase sleep—it is important to get adequate rest due to poor heart condition. In the case of mild Keshan's disease caused by a viral agent, the individuals doctor will advise them to have complete rest (and adequate fluids) for a specific period to help their body's immune system fight the infection and heal.

Supplements—an individual will most likely be prescribed selenium supplements (in the form of selenomethionine) or have injections of this mineral.

Surgery—if surgery has been advised (implants, stents or full heart transplant) the individual cardiac specialist will advise you about the pre- and post-operative care that they will need to undergo and how to best take care of themselves during this time, to avoid complications or worsening of any symptoms or health.[7]

See also


  1. Beck MA, Levander OA, Handy J (May 2003). "Selenium deficiency and viral infection". J. Nutr. 133 (5 Suppl 1): 1463S–7S. PMID 12730444.
  2. Ren LQ, Li XJ, Li GS, Zhao ZT, Sun B, Sun F (November 2004). "Coxsackievirus B3 infection and its mutation in Keshan disease". World J. Gastroenterol. 10 (22): 3299–302. PMID 15484304.
  3. "Vitamins Diary". Retrieved 2011-11-08.
  4. "Vital Health Zone". Retrieved 2011-11-08.
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