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Heart Attack in the Course of Lithium Overdose
Kalkan Asim1, Yeniocak Selman2, Yazici Suleyman3
1Department of Emergency Medicine, Recep Tayyip Erdogan Univercity Faculty of Medicine, Rize, Turkey.
Insights
Lithium overdose can cause acute myocardial infarction (AMI), particularly in older adults with heart conditions. Prompt lithium level monitoring and management are crucial for patients presenting with chest pain.
Area of Science:
- Cardiology
- Toxicology
- Pharmacology
Background:
- Lithium therapy is common for bipolar disorder and other psychiatric conditions.
- Elevated serum lithium levels can precipitate serious cardiac events, including acute myocardial infarction (AMI).
- Patients with pre-existing heart disease are at increased risk for lithium-induced cardiotoxicity.
Observation:
- A 62-year-old female presented with acute chest pain and ECG changes indicative of AMI.
- Her serum lithium level was significantly elevated at 2.3 mmol/L.
- Coronary angiography revealed no obstructive coronary artery disease.
Findings:
- The patient's cardiac symptoms and ECG abnormalities resolved upon lithium level normalization.
- This case highlights a direct correlation between lithium toxicity and acute myocardial infarction.
- Normal coronary angiography suggests lithium intoxication as the primary cause of AMI in this patient.
Implications:
- Lithium intoxication must be considered in the differential diagnosis of chest pain, especially in elderly patients on lithium.
- Early recognition and management of lithium toxicity can prevent severe cardiac complications.
- This case underscores the importance of therapeutic drug monitoring for lithium to avoid adverse cardiovascular events.
Introduction:
Lithium overdose can be associated with cardiac toxicity, especially in those with underlying heart disease. Toxic levels of serum lithium are associated with cardiotoxic effects ranging from simple ECG disorders to dysrhythmias, cardiomyopathy and even acute myocardial infarction (AMI). This report describes a patient with AMI accompanied by high blood levels of lithium.
Case Presentation:
A 62-year-old woman was admitted to the emergency department due to weakness and acute chest pain. Her ECG revealed ST elevation in leads DI, aVL and V5-6, with a ventricular rate of 80 bpm. Blood chemistry and complete blood count were within normal limits. The patient's blood lithium level was measured as 2.3 mmol/L (N: 0.5 - 0.8 mmol/L), and her troponin I level was 0.892 ng/mL (N: 0 - 0.01 ng/mL). Coronary angiography produced normal findings, concurrent with the resolution of electrocardiographic abnormalities following elimination of lithium. The clinical course in the intensive care unit was uneventful and the patient was discharged on the seventh day.
Conclusions:
Lithium intoxication should be considered in the differential diagnosis, especially in elderly patients on lithium therapy who are admitted to the emergency department with chest pain.