Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess the effect of long-term lithium therapy on cardiac arrhythmias and cardiovascular performance, extended ambulatory electrocardiographic monitoring was performed in 12 patients, and rest and exercise electrocardiograms in 10 of 12, before and during lithium therapy. Lithium increased the frequency of premature ventricular contractions in three patients, decreased it in one, and produced no change in eight. Three of four patients with atrial arrhythmias showed improvement during lithium therapy. Exercise performance was unchanged. Although 7 of the 12 patients manifested T wave flattening in the resting electrocardiogram, none had S-T segment displacement at rest or on treadmill exercise. Before lithium therapy, arrhythmias on exercise included premature atrial contractions in four patients, ventricular arrhythmias in four (premature ventricular contractions in four, with couplets in two and with ventricular tachycardia in one). During lithium therapy, exercise did not provoke premature atrial contractions or ventricular tachycardia in any of the patients, but three patients had premature ventricular contractions (with couplets in one case). We conclude that lithium at therapeutic levels may precipitate or aggravate ventricular arrhythmias. When administered to patients with heart disease, factors that interfere with renal clearance of lithium (heart failure, salt restriction, long-term diuretic therapy) must be recognized and doses must be adjusted accordingly. Careful follow-up and electrocardiographic monitoring are advisable if lithium is to be used in the presence of ventricular arrhythmias. Cardiovascular performance as assessed by treadmill exercise testing was not affected by long-term lithium therapy.
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PMID:Effect of lithium on cardiovascular performance: report on extended ambulatory monitoring and exercise testing before and during lithium therapy. 99 8

The 143 cases of lithium use during pregnancy collected by the Register of Lithium Babies show that infants exposed to lithium appear to have a higher than expected ratio of cardiovascular anomalies to all anomalies and may have an increased risk of congenital heart disease. The authors believe that these findings justify a conservative policy on the use of lithium with fertile and pregnant women.
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PMID:Cardiovascular malformations with lithium use during pregnancy. 111 12

The literature in most European languages was consulted for guidelines regarding the drug treatment of psychiatrically disturbed pregnant or lactating women. The available information allows only a few conclusions. Lithium exposure during the first trimester seems to increase the risk of congenital heart disease, especially Ebstein's anomaly. As there is still insufficient evidence to prove the safeness of other psychoactive drugs for the fetus, caution seems warranted here too. A causal link between pharmacotherapy of the mother-to-be and malformation of the baby is difficult to prove. But toxic and withdrawal symptoms in infants born to women treated regularly until shortly before confinement are well documented for most psychoactive drugs.
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PMID:Pharmacotherapy of psychiatric disorder in pregnancy and during breastfeeding: a review. 330 67

1. In this article some of the most important and tolerated drugs in the elderly are reviewed. 2. Tricyclic antidepressants have to be used carefully because of their important side effects. Nortriptyline and desipramine appear to be the best tolerated tricyclics in old people. 3. Second generation antidepressants are preferred for the elderly and those patients with heart disease as they have milder side effects and are less toxic in overdose. 4. MAO inhibitors are useful drugs in resistant forms of depression in which the above mentioned drugs have no efficacy and the last generation drugs (reversible MAO inhibitors), such as moclobemide, seem to be very successful. 5. Lithium is sometimes used especially to prevent recurrence of depression, even if its use is limited in old patients due to its side effects. 6. Psychotherapy is often used as an adjunct to pharmacotherapy, while electroconvulsant therapy is used only in the elderly patients with severe depression, high risk of suicide, or drug-resistant forms.
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PMID:Antidepressant drugs in the elderly. 952 61

Magnetic resonance imaging (MRI) provides detailed images of brain anatomy, with especially clear definition of gray and white matter structures. Several brain MRI studies have suggested that adults with bipolar disorder (BD) are more likely to have "white matter hyperintensities" (WMH) than adults without BD. The disproportionately greater frequency of these lesions in otherwise physically healthy patients suggests that the illness itself, or treatments used to control the illness, may be risk factors for the development of white matter changes. Similarly, WMH may be an etiological factor for some types of BD. In addition to reviewing the relevant literature, this research study attempted to determine whether lithium treatment is associated with an increased prevalence of WMH in young adults with psychiatric illness. To test this hypothesis, we evaluated over 600 brain MRI scans from inpatients at McLean Hospital, Belmont, Massachusetts. We controlled for possible confounding variables such as age, vascular disease, substance abuse, and markers of illness severity. We found that individuals with BD were no more likely to have WMH than other psychiatric patients. Lithium use was nonsignificantly associated with the presence of WMH. A multivariate regression model for the presence of WMH showed that heart disease, female gender, and multiple psychiatric admissions were significant predictors of WMH. This study does not support previous findings that BD, compared to other psychiatric illnesses, was associated with increased risk of WMH. Lithium use may be subtly associated with WMH. Our results are consistent with previous research that found an association between cardiovascular disease, advanced age, and the presence of WMH, though our analysis appears to be unique in its inclusion of cardiovascular disease as a risk factor in young adults with psychiatric illness.
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PMID:Clinical significance of brain white matter hyperintensities in young adults with psychiatric illness. 1455 27

If lithium therapy is required during pregnancy or lactation, serum lithium monitoring may be indicated in the newborns. In the neonatal population, however, blood samples are often obtained with a sampling device containing lithium heparin. Given the infrequent nature of lithium measurement in the neonatal population, a risk of oversight on the use of these lithium-containing devices for lithium measurements exists. Two such neonatal cases are reported, which may have been mismanaged if the measured levels of lithium were not suspected to be spurious. Patient 1 was a 3-day-old infant with a congenital heart disease born at 31 weeks' gestation to a mother on lithium. After a surgical repair, because of a potential need to monitor lithium in the infant's serum during breastfeeding, a remaining sample of apparently serum from a previous blood testing on day 1 of life was measured for lithium as a baseline value. Despite the lack of toxic signs, the result showed a toxic lithium level of 4.19 mmol/L. Lithium levels in follow-up samples were 0.11 mmol/L (day 4) and undetectable (day 6). Patient 2 was a full-term infant exposed to maternal lithium throughout the fetal life and breastfeeding. Serum lithium at day three of life in a hospital was undetectable, but after discharge, the lithium concentrations increased to 1.1 mmol/L on day 18, with no sign of lithium toxicity or renal dysfunction. This raised a possibility of significant exposure through breastfeeding, but later they were found to be spurious due to the use of lithium-containing devices. Separate investigation of effects of sampling devices on lithium levels indicated that levels of >3 mmol/L were possible if a sampling volume of blood was substantially small compared with the capacity of a tube containing lithium heparin [corrected]
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PMID:A pitfall of measuring lithium levels in neonates. 1905 75

This descriptive report describes the case of a 50 year-old woman with bipolar disorder, whose maintenance therapy comprised risperidone, sodium valproato and lithium carbonate without any past occurrence of toxicity. Her past medical history was significant for hypertension, cardiopathy and obesity. She presented with a 1-week history of fever, increasing confusion and slurred speech. At presentation, the patient was somnolent. Laboratory investigations revealed a serum creatinine of 3,6 mg/dl, BUN 45 mg/dl serum lithium 3,0 mEq/L with polyuria defined as more than 3 litres a day. EEG and ECG were abnormal. CT brain scanning and lumbar puncture were negative for brain haemorrage or infection. Lithium toxicity causes impairment of renal concentration and encephalopathy due to lithium recirculation, a mechanism responsible for the so-called cerebro-renal syndrome, where dialysis plays an important role in treatment.The patient was treated with continous veno-venous haemodiafiltration (CVVHDF) over 35 hours with gradual improvement of her general condition and efficacy of renal concentration. Our case highlights a few important points. Lithium nefrotoxicity and neurotoxicity can cause a cerebro-renal syndrome even when serum lithium levels are not particularly raised (2,5-3,5 mEq/L). Haemodialysis is the treatment of choice to reduce the molecular mechanisms of lithium-related changes in urinary concentration and reinstate dopaminergic activity in the brain.
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PMID:[The acute renal and cerebral toxicity of lithium: a cerebro-renal syndrome? A case report]. 2383 81