Nausea, Fatigue, and T-Wave Inversion: An Electrocardiographic Challenge

In adults, T-wave inversion on the 12-lead electrocardiogram (ECG) often raises suspicion for ischemia. However, in young adults, other potential etiologies become more likely. We present the case of an 18-year-old woman with a history of depression who presented to the emergency department with nausea, fatigue, and tremulousness. The ECG revealed precordial T-wave inversions.

Lithium competitively inhibits channels and pumps that control both slow-response action potentials (sinoatrial, atrioventricular nodal cells), and fast-response action potentials (Purkinje fibers, cardiomyocytes). As such, lithium intoxication can present with a wide spectrum of ECG abnormalities, most commonly T-wave inversion and QT prolongation.