A tick beat in the electrocardiogram: Persistent third degree block as only manifestation of Lyme disease

Jiménez-Castillo, Raúl Alberto; Carrizales-Sepúlveda, Edgar Francisco; Vera-Pineda, Raymundo; Herrera-Elizondo, José Luis; García-Sarreón, Alexis; Reyes-Mondragón, Alan Ledif; Mercado-Domínguez, Elizabeth; Marfil-Rivera, Luis Javier

doi:10.1016/j.jelectrocard.2018.12.005

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…LC is defined as acute AV conduction disturbance, usually above the bundle of His, myocarditis, or pancarditis. The most common presentation of LC is varying degrees of AV conduction block with the most severe form being complete AV block, which occurs within one month after the onset of infection [4,5]. LC has a predilection for young males with a male to female ratio of 3:1, and this difference in gender is more pronounced among patients with third-degree AV block.…”

Section: Discussionmentioning

confidence: 99%

“…The score assigns weights to risk factors, namely constitutional symptoms (fever, malaise, arthralgia, and dyspnea), outdoor activity/endemic area, male gender, tick bite, age <50 years, and presence of erythema migrans. The final summed score classifies patients to be low risk (0-2), intermediate-risk (3)(4)(5)(6), or high risk (7)(8)(9)(10)(11)(12). The implementation of this risk stratification tool helps prompt recognition of LC in patients with high-degree AV block.…”

Section: Discussionmentioning

confidence: 99%

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Third-Degree Atrioventricular Block as the Initial Presentation of Lyme Disease

Riaz

Garel

Subedi

et al. 2020

Cureus

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Lyme disease is a multisystemic infection that can present as localized disease, early disseminated, or late disease. During the early disseminated phase of Lyme disease, the hematogenous spread can result in extracutaneous manifestations, including cardiac, neurological, and joint. Lyme carditis is an uncommon manifestation occurring in patients with untreated Lyme disease. Third-degree atrioventricular (AV) block is a rarer entity. We present a case of a 21-year-old female with no significant past medical history admitted with thirddegree AV block and thereby highlighting this uncommon presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Third-Degree Atrioventricular Block as the Initial Presentation of Lyme Disease

Riaz

Garel

Subedi

et al. 2020

Cureus

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“…The sensitivity of SILC risk of Lyme carditis is 93.2%, but no specificity was reported. Our patient’s score was four (male, endemic area, presyncope), which puts him under intermediate risk of Lyme carditis [10, 11].…”

Section: Discussionmentioning

confidence: 99%

Lyme Carditis: A Rare Presentation of Sinus Bradycardia Without Any Conduction Defects

Grella

Patel

Tadepalli

et al. 2019

Cureus

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Lyme carditis is a rare cardiac manifestation of Lyme disease that occurs when bacterial spirochetes infect the pericardium or myocardium triggering an inflammatory response. The most common electrocardiogram (EKG) findings in these patients include atrioventricular (AV) conduction abnormalities (first, second, and third degree heart block).A 56-year-old male with a history of hypothyroidism, from the Northeastern region of the United States, presented to the emergency department with lightheadedness and chest pain. His EKG revealed sinus bradycardia with a heart rate of 49 beats per minute, without ST segment elevation, T wave inversions, or signs of heart block. An enzyme-linked immunosorbent assay (ELISA) Lyme titer was elevated, and confirmatory Western blot was positive for IgG and negative for IgM. He was treated with intravenous (IV) ceftriaxone; however, he continued to have persistent bradycardia with his heart rate dropping to 20 to 30 beats per minute throughout the night. Additionally, he had several sinus pauses while sleeping, with the longest lasting for 6.1 seconds. A pacemaker and an additional three-week course of IV ceftriaxone was determined to be the best treatment for his resistant bradycardia secondary to Lyme carditis. No symptoms were present at his one month follow-up appointment, as an outpatient, after completing ceftriaxone therapy. The patient follows up with cardiology regularly to have his pacemaker checked.Here we present a unique case of Lyme carditis, without the classical findings of Lyme disease or common EKG findings of AV conduction abnormalities. A high clinical suspicion of Lyme carditis is required when someone from a Lyme endemic region presents with unexplained cardiac symptoms and electrocardiogram abnormalities. This case report aims to add to the knowledge gap between suspicion of Lyme carditis and sinus bradycardia as the only presenting symptom.

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Is it proper to consider Lyme borreliosis as an autochthonous cause of cardiac disease in Mexico?

Faccini-Martínez

Rosas²

2020

Journal of Electrocardiology

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A tick beat in the electrocardiogram: Persistent third degree block as only manifestation of Lyme disease

Cited by 5 publications

References 11 publications

Third-Degree Atrioventricular Block as the Initial Presentation of Lyme Disease

Third-Degree Atrioventricular Block as the Initial Presentation of Lyme Disease

Lyme Carditis: A Rare Presentation of Sinus Bradycardia Without Any Conduction Defects

Is it proper to consider Lyme borreliosis as an autochthonous cause of cardiac disease in Mexico?

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