title: Unusual cause of syncope in a patient with ischemic heart disease.
abstract: Lithium is a commonly used drug for bipolar mood disorder. Though effective, it has a narrow therapeutic range and has potentially life-threatening effects at higher serum levels. Lithium toxicity can be precipitated by several drug interactions. Many commonly used cardiac drugs have serious drug interaction with lithium which is not commonly known in clinical practice. We present a case where a patient on lithium therapy since 15 years, presented with sinus arrest and syncope due to lithium toxicity, within 2 weeks of initiation of low dose angiotensin converting enzyme (ACE) inhibitor. The patient however needed temporary pacemaker support and had an uneventful recovery, without the need for a permanent pacemaker, once the lithium levels fell down to normal.
authors.affiliation: Department of Cardiology, GB Pant Hospital and associated Maulana Azad Medical College, New Delhi, India.
authors.forename: Mohit D
authors.initials: MD
authors.lastname: Gupta
authors.lastname: Girish
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.forename: Msk
authors.initials: M
authors.lastname: Subhendu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Tyagi
mesh_terms: D001714:Bipolar Disorder / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D013575:Syncope / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*
chemical_list: D016651:Lithium Carbonate
keywords: angiotensin converting enzyme inhibitor; drug interaction; lithium toxicity; sinus node dysfunction