In the Lymelight: A Mysterious Case of Heart Block (original) (raw)
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Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back
Case Reports in Cardiology, 2016
Carditis is an uncommon presentation of the early disseminated phase of Lyme disease. We present the case of a young female who presented with erythema migrans and was found to have first-degree heart block which progressed to complete heart block within hours. After receiving ceftriaxone, there was complete resolution of the heart block in sequential fashion. Our case illustrates the importance of early recognition and anticipation of progressive cardiac conduction abnormalities in patients presenting with Lyme disease.
IDCases, 2018
Lyme disease may present with a variety of cardiac manifestations ranging from first degree to third degree heart block. Cardiac involvement with Lyme disease may be asymptomatic, or symptomatic. Atrioventrical conduction abnormalities are the most common manifestation of Lyme carditis. Less common, are alternating right bundle branch block (RBBB) and left bundle branch block (LBBB). We present an interesting case of a young male whose main manifestation of Lyme carditis was isolated LBBB. He also had mild Lyme myocarditis. The patient was successfully treated with oral doxycycline, and his isolated LBBB and myocarditis rapidly resolved.
Cardiac implications of Lyme disease, diagnosis and therapeutic approach
International Journal of Cardiology, 2008
Lyme is a tick-borne disease. The genetic diversity of Borreliae its distribution worldwide and its epidemiology have been related to different clinical manifestations. Carditis is a rare manifestation of Lyme disease. The commonest abnormality is atrioventricular block of various degrees, though other rhythm abnormalities have been reported. Pericarditis, myocarditis, cardiomyopathy and degenerative valvular disease have been associated with B. burgdorferi. Temporary pacing might be required in unstable patients. The majority of the conduction disturbances have a benign prognosis, if the infectious agent is identified and treated appropriately.
Indian Heart Journal, 2014
Lyme carditis is a known cause of atrioventricular block and in most cases, atrioventricular block is reversible with appropriate antibiotic treatment. The diagnosis can be challenging if the disease is either not suspected, or if the initial cutaneous manifestation of erythema migrans is missed. It is important to diagnose Lyme carditis as the cause of complete heart block if unnecessary pacemaker implantation is to be avoided. We present a 43-year-old male who presented with complete heart block and also illsustained ventricular tachycardia due to Lyme carditis that reversed completely with antibiotic therapy.
Lyme carditis: Sequential electrocardiographic changes in response to antibiotic therapy
International Journal of Cardiology, 2009
Lyme disease is a tick-borne spirochetal infection that may involve heart. The cardiac manifestations of Lyme disease including varying degrees of atrioventricular heart block occur within weeks to months of the infecting tick bite. This report describes a 43 year-old man with Lyme carditis who presented with complete heart block. The heart block resolved with ceftriaxone therapy. Lyme carditis should be considered in the differential diagnosis in patients who present with new onset advanced heart block.
Lyme-Associated Pericarditis: A Case Report and Literature Review
Curēus, 2024
Lyme disease is caused by Borrelia burgdorferi (B. burgdorferi), which is a spirochete transmitted by ticks of the genus Ixodes. Complications related to the cardiovascular system usually occur in the early phase of infection, and the most common cardiovascular complication of Lyme disease is atrioventricular block, especially third-degree heart block. We report a case of a young Caucasian male patient who presented to the emergency department (ED) with complaints of chest pain and shortness of breath. Initial investigations, including chest X-ray, were negative. An EKG revealed ST elevation and PR depression with troponin elevation. The echocardiogram showed a normal ejection fraction with no pericardial effusion. Skin examination was positive for erythema migrans concerning Lyme. Initial Lyme testing was negative in the patient and it should be repeated after four to six weeks, according to the guidelines. This case report highlights the importance of keeping the differentials broad in these patients even if the initial testing is negative, especially since misdiagnosis or delayed diagnosis can cause cardiac complications.
Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction
Journal of Community Hospital Internal Medicine Perspectives, 2017
A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1 mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL. The patient underwent cardiac catheterization which did not show any significant obstructive coronary artery disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome.
Complete Heart Block Due to Lyme Carditis in Two Pediatric Patients and a Review of the Literature
Congenital Heart Disease, 2007
Carditis is a common manifestation of adult patients with Lyme disease affecting 4-10% of Lyme patients in the United States. However, children with Lyme disease rarely present with acute carditis. The management of pediatric patients with complete heart block (CHB) secondary to Lyme carditis has not been well described. We report the acute management of 2 pediatric patients that presented in CHB secondary to Lyme disease.
Cardiovascular manifestations of Lyme disease
American Heart Journal, 1991
Lyme disease is caused by the treponema-like spirochete Borrelia burgdorferi.' Since Steere et al2 described the geographic clustering of cases in Lyme, Connecticut, over a decade ago, the disease has been recognized to be worldwide in distribution3 and has become the leading tick-associated illness in North America and Europe. 4*5 Although Lyme disease is known to affect primarily the skin, heart, nervous system, and joints, the cardiac manifestations that occur in 4 % to 10 % of cases5* 6-8 remain the least well documented. The purpose of this report is to summarize the manifestations and management of cardiac involvement in Lyme disease.