Heart Attack in the Course of Lithium Overdose

Kalkan, Ahmet; Yeniocak, Selman; Yazici, Suleyman; Karcıoğlu, Özgür; Bilir, Özlem; Ersunan, Gökhan

doi:10.5812/ircmj.21731

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…Serious cardiac toxicity due to lithium is uncommon and generally occurs in individuals with an underlying heart disease [82]. Following acute lithium overdose, there is some description of reversible global or segmental LF dysfunction, with a possible overlap with takotsubo cardiomyopathy [83][84][85]. Drug safety databases are suggesting an association between lithium treatment and the development of dilated cardiomyopathy, but these data must be interpreted with caution due to numerous biases including the presence of a preexisting cardiac disease.…”

Section: Lithiummentioning

confidence: 99%

Mechanisms of toxic cardiomyopathy

Hantson

2018

Clinical Toxicology

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Background: Dilated cardiomyopathy is a frequent disease responsible for 40-50% of cases of heart failure. Idiopathic cardiomyopathy is a primary disorder often related to familial/genetic predisposition. Before the diagnosis of idiopathic cardiomyopathy is made, clinicians must not only rule out viral and immune causes, but also toxic causes such as drugs, environmental agents, illicit substances and natural toxins. Objective: The objective of this review is to present recent data on the mechanisms underlying toxic cardiomyopathy. Methods: The US National Library of Medicine Pubmed database was searched from 1980 to December 2017 utilizing the combinations of the search terms "toxic cardiomyopathy", "drugs", "anticancer drugs", "azidothymidine", "rosiglitazone", "carbon monoxide", "alcohol", "illicit drugs", "cocaine", "metamfetamine", "metals", "venom". A total of 339 articles were screened and papers that dealt with the pathophysiology of toxic cardiomyopathy, either in animal models or in clinical practice were selected, with preference being given to more recently published papers, which left 92 articles. Anticancer drugs: The mechanisms of anthracycline-induced cardiotoxicity are primarily related to their mechanisms of action as anticancer drugs, mainly the inhibition of topoisomerase II b and DNA cleavage. Additional metabolic or oxidative stress factors may play a part, together with interference with iron metabolism. The more recent drugs, trastuzumab and imatinib, also influence stress pathways. Antiretroviral agents: Azidothymidine is cardiotoxic as a result of mitochondrial toxicity. In addition to energy depletion, azidothymidine also increases the production of mitochondrial reactive oxygen species (ROS). Antidiabetic drugs: The cardiotoxicity of thiazolidinedione antidiabetic drugs is still under investigation, though interference with mitochondrial respiration or oxidative stress is suspected. Cocaine: Among the multiple mechanisms involved in cocaine-related cardiotoxicity, excessive sympathetic stimulation with increased myocardial oxygen consumption is well documented in the acute form of left ventricular dysfunction. As for cocaine-related cardiomyopathy, the role of apoptosis and ROS is under investigation. Ethanol: The aetiology of ethanol-related cardiotoxicity is multifactorial, with individual susceptibility being important. It involves apoptosis, alterations of the excitation-contraction coupling in cardiac myocytes, structural and functional alterations of the mitochondria and sarcoplasmic reticulum, changes in cytosolic calcium flows, changes in calcium sensitivity of myofilaments, alterations of mitochondrial oxidation, deregulation of protein synthesis, decrease of contractile proteins and disproportion between the different types of myofibrils, changes in the regulation of myosin ATPase, up-regulation of the L-type calcium channels, increase of oxidative stress, and induction of ANP and p21 mRNA expression in ventricular myocardium. Metamfetamines: Catecholamine-mediated toxicity i...

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Section: Lithiummentioning

confidence: 99%

Mechanisms of toxic cardiomyopathy

Hantson

2018

Clinical Toxicology

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“…It is recommended to closely monitor hydration status, renal function, and salt balance in individuals on lithium. Caution should also be taken in individuals already on other mood stabilizers and anti-seizure medications as such medications can interact with the lithium effect on ion channels [17].…”

Section: Discussionmentioning

confidence: 99%

Lithium-induced Cardiotoxicity: A Rare Clinical Entity

Acharya

Siddiqui

Anwar

et al. 2020

Cureus

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Lithium has been used effectively used in the management of mood disorders, such as bipolar disease, acute mania, and hypomania. As the therapeutic index is very narrow for lithium, it is important to monitor lithium levels periodically to avoid toxic effects. Common toxic effects include diarrhea, tremor, muscle weakness, ataxia, and myoclonus. Severe toxicity can present with seizures, coma, and death. Cardiotoxicity secondary to lithium is rarely reported in the medical literature and can range from dysrhythmias and cardiomyopathies to myocardial infarction. We describe an interesting case report of cardiac toxicity secondary to lithium in a bipolar patient managed conservatively in an intensive care setting.

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“…angiography. 7 In these cases, the ECG pattern normalised after restoring normal values of blood lithium levels. This was the case in our patient as well, who reported no chest pain, showed no reciprocal changes on ECG, no dynamic changes in cardiac biomarkers and presented no wall-motion anomalies on TTE.…”

Section: Case Reportmentioning

confidence: 90%

Lithium-induced ECG modifications: navigating from acute coronary syndrome to Brugada syndrome

et al. 2021

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Lithium is frequently used in the treatment of bipolar disorders and is known to induce ECG alterations. This case study describes various patterns of lithium-induced ECG modifications in a patient with acute-on-chronic lithium intoxication. Clinicians should be familiar with this problem as it can have life-threatening consequences and lead to important changes in patient’s management. Our patient was admitted for acute delirium with an ECG showing atrial fibrillation with wide QRS and ST-segment elevation. These modifications were first mistaken for an acute myocardial infarction and a diagnosis of Brugada syndrome was finally reached. Treatment after the acute phase implied changes in the therapeutic modality and required frequent monitoring.

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Heart Attack in the Course of Lithium Overdose

Cited by 8 publications

References 9 publications

Mechanisms of toxic cardiomyopathy

Mechanisms of toxic cardiomyopathy

Lithium-induced Cardiotoxicity: A Rare Clinical Entity

Lithium-induced ECG modifications: navigating from acute coronary syndrome to Brugada syndrome

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