Heart Attack in the Course of Lithium Overdose

INTRODUCTION: Lithium overdose can be associated with cardiac toxicity, especially in those with underlying heart disease. Toxic levels of serum lithium are associated with cardiotoxic effects ranging from simple ECG disorders to dysrhythmias, cardiomyopathy and even acute myocardial infarction (AMI). This report describes a patient with AMI accompanied by high blood levels of lithium. CASE PRESENTATION: A 62-year-old woman was admitted to the emergency department due to weakness and acute chest pain. Her ECG revealed ST elevation in leads DI, aVL and V5-6, with a ventricular rate of 80 bpm. Blood chemistry and complete blood count were within normal limits. The patient’s blood lithium level was measured as 2.3 mmol/L (N: 0.5 - 0.8 mmol/L), and her troponin I level was 0.892 ng/mL (N: 0 - 0.01 ng/mL). Coronary angiography produced normal findings, concurrent with the resolution of electrocardiographic abnormalities following elimination of lithium. The clinical course in the intensive care unit was uneventful and the patient was discharged on the seventh day. CONCLUSIONS: Lithium intoxication should be considered in the differential diagnosis, especially in elderly patients on lithium therapy who are admitted to the emergency department with chest pain.