A 54-year-old man was hospitalized with respiratory failure. Arterial blood gases showed severe metabolic acidosis at the time of admission, and chest X-ray films disclosed cardiac enlargement and increased pulmonary markings. Two-dimensional and Doppler echocardiogram showed hyperkinetic heart motion and pulmonary hypertension; left ventricular diastolic function assessed by left ventricular inflow pattern was normal; and right-heart catheterization revealed high-output status and pulmonary hypertension. A diagnosis of shoshin beriberi was made. Pulmonary congestion disappeared after administration of thiamine, and output status returned to normal. Left ventricular inflow pattern showed an abnormal relaxation pattern when systemic vascular resistance and blood pressure were elevated. Left ventricular inflow pattern returned to normal as blood pressure normalized after vasodilator administration. Thus, two-dimensional and Doppler echocardiography may prove useful in serial assessment of systolic and diastolic function in patients with shoshin beriberi.