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Lithium-Induced Bradycardia and Cardiomyopathy in a Patient With Bipolar Disorder and Paranoid Schizophrenia

Mahnoor Khalid1,2, Wasiq Sheikh3,4, Mahnoor Sherazi5

  • 1Internal Medicine, Foundation University Medical College, Islamabad, PAK.

Cureus
|July 28, 2023
PubMed

Insights

Lithium toxicity can rarely cause heart problems, including slow heart rhythms and cardiomyopathy. This case highlights the importance of monitoring lithium levels to prevent cardiac complications.

Area of Science:

  • Cardiology
  • Psychiatry
  • Toxicology

Background:

  • Lithium is a common mood stabilizer for bipolar disorder and schizophrenia.
  • Neurological and gastrointestinal side effects are well-documented.
  • Cardiac effects of lithium are rarely reported but can be severe.

Observation:

  • A 68-year-old male patient presented with altered mental status, bradycardia (42 bpm), and acute kidney injury.
  • Elevated lithium levels were detected, prompting suspicion of lithium toxicity.
  • Electrocardiogram showed a junctional escape rhythm, indicative of a heart block.

Findings:

  • The patient was diagnosed with lithium-induced junctional bradycardia and cardiomyopathy.
  • Bradycardia resolved as serum lithium levels decreased with supportive care.
  • Echocardiogram confirmed moderate left ventricular systolic dysfunction, attributed to lithium.

Implications:

  • Lithium cardiotoxicity can manifest as arrhythmias and/or cardiomyopathy.
  • Clinicians must maintain a high index of suspicion for cardiac effects in patients on lithium.
  • Close monitoring of lithium levels is crucial due to its narrow therapeutic range and potential for severe toxicity.

Keywords:
chronic lithium therapydrug-induced cardiomyopathylithium induced cardiotoxicitylithium poisoninglithium-induced bradycardia

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