title: [Complete atrioventricular block during lithium therapy within  therapeutic range].
abstract: METHODS
  A 69-year-old man came to the emergency unit because of vertigo and presyncope. A bipolar disorder - known since an age of 15 years - has been treated with 2 × 450 mg lithium and 100 mg perazine per day for several years (no other medications). With the exception of a low heart rate (36/min) clinical examination findings were unremarkable.
  
  
  METHODS
  Electrocardiography revealed a permanent complete atrioventricular block with a heart rate of 36/min. Echocardiography showed a normal left ejection fraction (EF 65 %). Laboratory tests were mainly unremarkable, particularly the lithium levels (0,7 mmol/l) were within the therapeutic range.
  
  
  METHODS
  Continuous treatment with orciprenaline stabilized the heart rate at an average of 52/min. After pacing with a provisional pacemaker a permanent pacemaker was implanted without complications, and the symptoms of vertigo and dizziness disappeared. Pacemaker checkup on the following day still showed a complete atrioventricular block with a heart rate of 28/min.
  
  
  CONCLUSIONS
  Complete atrioventricular block secondary to chronic lithium therapy even in therapeutic levels is a rare complication with poor prognosis. Therefore it should be treated consequently.
authors.affiliation: Evangelisches Krankenhaus Herne, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen. a.halboos@evk-herne.de
authors.forename: A
authors.initials: A
authors.lastname: Halboos
authors.forename: F
authors.initials: F
authors.lastname: Jockenhövel
mesh_terms: D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D010138:Pacemaker, Artificial; D010464:Perazine / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D012815:Signal Processing, Computer-Assisted
chemical_list: D018692:Antimanic Agents; D016651:Lithium Carbonate; D010464:Perazine