Chronic Lithium-Induced Cardiotoxicity: A Case Report and Lessons for Clinical Practice

Area of Science:

• Cardiology
• Nephrology
• Psychiatry

Background:

• Lithium is a common treatment for bipolar disorders, primarily associated with neurological and renal side effects.
• Cardiac side effects of lithium are infrequently reported but can be severe.
• Chronic lithium use without supervision increases the risk of toxicity.

Observation:

• An 80-year-old woman presented with loss of consciousness and severe sinus bradycardia, indicative of sinus node dysfunction.
• Electrocardiogram revealed significant cardiac rhythm abnormalities.
• The patient was found to be on long-term lithium treatment without medical oversight, leading to lithium intoxication.

Findings:

• Discontinuation of lithium resulted in the resolution of both neurological and cardiac symptoms.
• The patient's cardiac function normalized, allowing for pacemaker removal.
• Serum lithium levels confirmed lithium intoxication as the cause of the patient's condition.

Implications:

• Lithium's narrow therapeutic range necessitates routine monitoring to prevent toxicity.
• Clinicians must consider cardiac manifestations, including arrhythmias and bradycardia, in cases of suspected lithium toxicity.
• Awareness of rare cardiac effects is crucial for accurate diagnosis and management of lithium-treated patients.