Cardiomyopathy after long-term treatment with lithium - more than a coincidence?

We describe a patient suffering from dilative cardiomyopathy after 16 years of treatment with lithium carbonate. The literature concerning lithium and cardiac adverse reactions is briefly reviewed. There is good evidence for acute cardiac reactions, especially cardiac arrhythmia but a rather speculative association with long-term reactions such as cardiomyopathy. Nevertheless clinicians should be aware of this rare but life threatening conjunction of cardiac disease and lithium treatment.