Tilkian A G, Schroeder J S, Kao J J, Hultgren H N
Am J Med. 1976 Nov;61(5):665-70. doi: 10.1016/0002-9343(76)90145-5.
The medical literature since 1900 has been reviewed to determine the nature of lithium's cardiovascular effects. In therapeutic doses, lithium produces reversible T wave flattening and inversion in the electrocardiogram: rarely, it may cause sinus node dysfunction or ventricular arrhythmias. Patients with lithium toxicity almost always present with neurologic signs and symptoms. "Hypotension and cardiovascular collapse," alleged cardiotoxic manifestations of lithium, invariably follow days of coma. Given the possible cardiotoxic effect other psychopharmacologic agents and the hazards of withholding effective therapy in mania, it is concluded that lithium may be used safely in patients with cardiac disease if the dose is adjusted to the rate of lithium excretion and if serum levels of lithium are followed carefully. When used in patients with cardiac arrhythmias, frequent electrocardiographic monitoring is advised.
对1900年以来的医学文献进行了回顾，以确定锂对心血管系统影响的性质。治疗剂量的锂可使心电图出现可逆的T波低平及倒置；少数情况下，可能导致窦房结功能障碍或室性心律失常。锂中毒患者几乎总会出现神经学体征和症状。锂所谓的心脏毒性表现“低血压和心血管虚脱”总是在昏迷数日后出现。鉴于其他精神药物可能存在心脏毒性作用，以及在躁狂症患者中停用有效治疗的风险，得出的结论是，如果根据锂的排泄速率调整剂量并仔细监测血清锂水平，锂可在心脏病患者中安全使用。用于心律失常患者时，建议频繁进行心电图监测。
