Advanced AV-block: Is it time to consider Lyme carditis as a differential diagnosis in Mexico?

Lyme carditis (LC) is an early-disseminated manifestation of Lyme disease, most commonly presenting as high-degree atrioventricular block (AVB). The degree of AVB can fluctuate rapidly within minutes, and progression to third-degree AVB is potentially fatal if not recognized and managed promptly. However, the AVB in LC is often transient, and usually resolves with appropriate antibiotic therapy. LC should be on the differential diagnosis in young patients presenting with new high-degree AVB and factors that increase the index of suspicion for Lyme disease. The Suspicious Index in Lyme Carditis (SILC) score helps clinicians risk stratify for LC. A systematic approach to the diagnosis and treatment of LC minimizes the unnecessary implantation of permanent pacemakers.

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A rare and reversible cause of third-degree atrioventricular block: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab372 ◽

2021 ◽

Vol 5 (10) ◽

Author(s):

Gino Lee ◽

Patrick Badertscher ◽

Christian Sticherling ◽

Stefan Osswald

Keyword(s):

Atrioventricular Block ◽

Structural Heart Disease ◽

Av Block ◽

Lyme Carditis ◽

Escape Rhythm ◽

Av Conduction ◽

Complete Av Block ◽

Third Degree Atrioventricular Block ◽

Rule Out ◽

New Onset

Abstract Background Cardiac involvement of Lyme disease (LD) typically results in atrioventricular (AV) conduction disturbance, mainly third-degree AV block. Case summary A 54-year-old patient presented to our emergency department due to recurrent syncope. Third-degree AV block with a ventricular escape rhythm (33 b.p.m.) was identified as the underlying rhythm. Transthoracic echocardiography (TTE) was normal. To rule out common reversible causes of complete AV block, a screening test for Lyme borreliosis was carried out. Elevated levels for borrelia IgG/IgM were found and confirmed by western blot analysis. Lyme carditis (LC) was postulated as the most likely cause of the third-degree AV block given the young age of the patient. Initiation of antibiotic therapy with ceftriaxone resulted in a gradual normalization of the AV conduction with stable first-degree AV block on Day 6 of therapy. The patient was changed on oral antibiotics (doxycycline) and discharged without a pacemaker. After 3 months, the AV conduction recovered to normal. Discussion Lyme carditis should always be considered, particularly in younger patients with new-onset AV block and without evidence of structural heart disease. Atrioventricular block recovers in the majority of cases after appropriate antibiotic treatment.

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Lyme Carditis Presenting as Sinus Node Dysfunction and Accelerated Junctional Rhythm

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/106 ◽

2020 ◽

Vol 3 (12) ◽

pp. 01-03

Author(s):

Saima Karim ◽

Roy Arjoon ◽

B. Julie He ◽

Lynda Rosenfeld ◽

Paras Bhatt

Keyword(s):

Lyme Disease ◽

Cardiac Involvement ◽

Sinus Node ◽

Sinus Node Dysfunction ◽

High Index ◽

Av Block ◽

Junctional Rhythm ◽

Lyme Carditis ◽

Uncommon Presentation ◽

High Index Of Suspicion

Lyme disease can have cardiac involvement and can subsequently present with various types of atrio ventricular (AV) block. Sinus node dysfunction (SND) and accelerated junctional rhythm are highlighted in this case as an uncommon presentation for Lyme Carditis. This case highlights the importance of having a high index of suspicion for cardiac involvement with Lyme disease when atypical arrhythmias are present.

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A Case of Lyme Carditis Presenting with Atrial Fibrillation

Case Reports in Cardiology ◽

10.1155/2018/5265298 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Peter J. Kennel ◽

Melvin Parasram ◽

Daniel Lu ◽

Diane Zisa ◽

Samuel Chung ◽

...

Keyword(s):

Atrial Fibrillation ◽

Borrelia Burgdorferi ◽

Antibiotic Therapy ◽

Unusual Presentation ◽

Type I ◽

Atrial Arrhythmias ◽

Av Block ◽

Lyme Carditis ◽

Second Degree

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

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Treating Lyme carditis high‐degree AV block using a temporary–permanent pacemaker

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12599 ◽

2018 ◽

Vol 24 (3) ◽

pp. e12599 ◽

Cited By ~ 3

Author(s):

Chang Wang ◽

Sanoj Chacko ◽

Hoshiar Abdollah ◽

Adrian Baranchuk

Keyword(s):

Permanent Pacemaker ◽

Av Block ◽

Lyme Carditis ◽

High Degree

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Lyme Carditis: A Case Report and Review of Management

Hospital Pharmacy ◽

10.1177/0018578717749927 ◽

2018 ◽

Vol 53 (4) ◽

pp. 263-265 ◽

Cited By ~ 2

Author(s):

Sheheryar Muhammad ◽

Robert J. Simonelli

Keyword(s):

Heart Rate ◽

Case Report ◽

Erythema Migrans ◽

Acute Onset ◽

Unknown Etiology ◽

Type I ◽

Av Block ◽

Presumptive Diagnosis ◽

Lyme Carditis ◽

Mobitz Type

Purpose: A case report of a patient who presented with an acute onset, fluctuating atrioventricular (AV) block and was diagnosed with Lyme carditis is presented. Summary: A 55-year-old man with progressively worsening generalized malaise, flu-like symptoms, dyspnea on exertion, and near syncope was admitted with bradycardia (heart rate was between 20 and 30 beats per minute upon admission). He endorsed having several tick bites after which he developed erythema migrans on his arm and abdomen. An electrocardiogram (ECG) revealed a second-degree AV block, fluctuating between Mobitz type I and Mobitz type II heart block, with a P-R interval of 300 ms. A presumptive diagnosis of Lyme carditis was made based on a confirmed history of tick exposure, presence of erythema migrans, and AV block. The patient was started on ceftriaxone. On day 3 of hospitalization, patient’s heart rate was between 50 and 60 beats per minute. A diagnosis of Lyme disease was confirmed based on serologic testing. A repeat ECG revealed a first-degree AV block with a P-R interval of 300 ms. On day 5 of hospitalization, a peripherally inserted central catheter line was placed and the patient was discharged to his home on a 28-day course of ceftriaxone. Patient’s heart rate was 65 beats per minute on discharge day. Conclusion: Considering Lyme carditis as a differential diagnosis in patients with an AV block of an unknown etiology can result in a timely diagnosis and treatment of Lyme carditis.

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Lyme Carditis: A Reversible Cause of Acquired Third-Degree AV Block

American Journal of Case Reports ◽

10.12659/ajcr.927885 ◽

2021 ◽

Vol 22 ◽

Author(s):

Abayomi Bamgboje ◽

Florence O. Akintan ◽

Niyati M. Gupta ◽

Gurpinder Kaur ◽

Gerald Pekler ◽

...

Keyword(s):

Av Block ◽

Lyme Carditis

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Lyme Carditis Buried Beneath ST-Segment Elevations

Case Reports in Cardiology ◽

10.1155/2017/9157625 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Basia Michalski ◽

Adrian Umpierrez De Reguero

Keyword(s):

Lyme Disease ◽

Heart Block ◽

Normal Sinus Rhythm ◽

Young Patients ◽

Acute Myocardial Ischemia ◽

Av Block ◽

Normal Sinus ◽

Lyme Carditis ◽

St Segment ◽

Common Manifestation

Lyme disease is caused by the spirochete Borrelia burgdorferi and is carried to human hosts by infected ticks. There are nearly 30,000 cases of Lyme disease reported to the CDC each year, with 3-4% of those cases reporting Lyme carditis. The most common manifestation of Lyme carditis is partial heart block following bacterial-induced inflammation of the conducting nodes. Here we report a 45-year-old gentleman that presented to the hospital with intense nonradiating chest pressure and tightness. Lab studies were remarkable for elevated troponins. EKG demonstrated normal sinus rhythm with mild ST elevations. Three weeks prior to hospital presentation, patient had gone hunting near Madison. One week prior to admission, he noticed an erythematous lesion on his right shoulder. Because of his constellation of history, arthralgias, and carditis, he was started on ceftriaxone to treat probable Lyme disease. This case illustrates the importance of thorough history taking and extensive physical examination when assessing a case of possible acute myocardial infarction. Because Lyme carditis is reversible, recognition of this syndrome in young patients, whether in the form of AV block, myocarditis, or acute myocardial ischemia, is critical to the initiation of appropriate antibiotics in order to prevent permanent heart block, or even death.

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