Electrocardiographic changes caused by lithium intoxication in an elderly patient

Abstract

Lithium intoxication can cause serious cardiac toxicity and is associated with electrocardiogram (ECG) changes. This paper described a case of a 76-year-old man who was lithium intoxicated and showed a variety of ECG abnormalities including sinus bradycardia, rapid atrial fibrillation, second-degree atrioventricular block and T wave changes. We monitored his ECGs during the after 3 days consecutively. After hemodialysis, his ECG abnormalities partially eased along with his serum lithium concentration decreased.

The molecular mechanisms of lithium-induced cardiotoxicity in male rats and its amelioration by N-acetyl cysteine

“…39 Lithium-induced sinus node dysfunction has even been reported in its therapeutic range. 40 In addition, the current study reported ventricular dysrhythmia in the lithiumtreated group in accordance with Chen et al 15 Various ECG changes have been reported in lithium overdose such as junctional bradycardia, complete heart block, and first-degree atrioventricular block. [41][42][43] The current work showed also that lithium caused a depressed ST segment, decreased amplitude of R wave, and narrow PR interval.…”

“…8 Lithium affects a wide range of cellular functions through inhibiting the production of inositol, and it also affects the protein kinase C signaling pathway and inhibits glycogen synthase kinase 3. 9 Although there are several human reports demonstrating that lithium induces cardiotoxicity, [10][11][12][13][14][15] there are minimal systemized studies of lithium-induced cardiac effects and their underlying mechanisms. The cardiotoxic effects of lithium range from simple electrocardiogram (ECG) abnormalities to dysrhythmias, cardiomyopathy, and even acute myocardial infarction (AMI).…”

Lithium-induced Cardiotoxicity: A Rare Clinical Entity

“…These changes can cause hypercalcemia and hypokalemia, thereby interfering in electrical impulse propagation and depolarization manifested on electrocardiograms [8][9]. A wide range of these cardiac effects has been discussed in the literature that includes junctional rhythm, atrial fibrillation, ST-segment and T-wave changes, atrioventricular blocks, and sinus node arrhythmias [10][11][12][13]. It is of note that the aforementioned electrocardiographic changes are usually demonstrated in patients who may have chronically elevated lithium levels, especially > 1.5 mmol/L, but such arrhythmias can be precipitated with changes in lithium levels in a short time interval, as seen in our clinical case [14].…”