Clues to Bradycardia in a Psychiatric Patient can be Revealed by Good History-Taking: A Case Report and Literature Review

  • Mohammad Abu-Abaa Capital Health Regional Medical Center, Trenton, NJ, USA
  • Maryam Al-Mohammed Capital Health Regional Medical Center, Trenton, NJ, USA
  • Aliaa Mousa Capital Health Regional Medical Center, Trenton, NJ, USA

Keywords

Lithium, bradycardia, pacemaker, hyperparathyroidism, hypothyroidism

Abstract

Lithium is a medication commonly used as a mood stabilizer and can have numerous long-lasting side effects. In this case report, we aim to remind clinicians of such consequences. A 68-year-old woman with a psychiatric history presented for mild COVID-19 and developed sinus bradycardia. A permanent pacemaker was planned for her but was cancelled following good history-taking which revealed prior lithium use. The patient was found to have hyperparathyroidism and hypothyroidism, treatment of which resolved the bradycardia. This case serves to remind clinicians that history-taking remains of paramount importance as in this scenario of bradycardia in a psychiatric patient. An invasive therapeutic measure was precluded by good history-taking. There are several mechanisms by which hypothyroidism and hyperparathyroidism can induce bradycardia. COVID-19 infection can also induce bradycardia.

VIEW THE ENTIRE ARTICLE

References

  • Liu F, Xin Z, Xia Y, Yin X. Bradycardia secondary to primary hyperparathyroidism. J Int Med Res 2019;47(5):2309–2311. doi:10.1177/0300060519841156
  • Bronsky D, Dubin A, Waldstein SS, Kushner DS. Calcium and the electrocardiogram II. The electrocardiographic manifestations of hyperparathyroidism and of marked hypercalcemia from various other etiologies. Am J Cardiol 1961;7:833–839.
  • Guimarães T, Nobre Menezes M, Cruz D, do Vale S, Bordalo A, Veiga A, et al. Hypercalcemic crisis and primary hyperparathyroidism: cause of an unusual electrical storm. Rev Port Cardiol 2017;36:959. https://doi.org/10.1016/j.repce.2016.12.025
  • Thotakura S, Stafford J, Barnett B, Slicker K, Kramer D, Gupta R. Complete AV nodal block due to malignancy-related hypercalcemia. Fed Pract 2016;33:23–25.
  • Vosnakidis A, Polymeropoulos K, Zarogoulidis P, Zarifis I. Atrioventricular nodal dysfunction secondary to hyperparathyroidism. J Thorac Dis 2013;5:E90–92.
  • Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J 2017;13(2):55–59. doi: 10.14797/mdcj-13-2-55. PMID: 28740582; PMCID: PMC5512679.
  • Gopinathannair R, Merchant FM, Lakkireddy DR, Etheridge SP, Feigofsky S, Han JK, et al. COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies. J Interv Card Electrophysiol 2020;59(2):329–336.
  • Amaratunga EA, Corwin DS, Moran L, Snyder R. Bradycardia in patients with COVID-19: a calm before the storm? Cureus 2022;12(6):e8599. doi: 10.7759/cureus.8599. PMID: 32550090; PMCID: PMC7294893.
  • Mehta, N, Vannozzi, R. Lithium-induced electrocardiographic changes: a complete review. Clin Cardiol 2017;40:1363–1367. https://doi.org/10.1002/clc.22822
  • Sarangi A, Javed S, Paul T, Amor W. Lithium-induced sinoatrial node dysfunction. Cureus 2021;13(7):e16778. doi:10.7759/cureus.16778
  • Published: 2022-09-01

    Issue: 2022: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    1.
    Abu-Abaa M, Al-Mohammed M, Mousa A. Clues to Bradycardia in a Psychiatric Patient can be Revealed by Good History-Taking: A Case Report and Literature Review. EJCRIM 2022;doi:10.12890/2022_003538.