ro13-9904 and Atrioventricular-Block

A 34-year-old road builder was admitted to the authors' emergency department due to progressive dyspnoea that had been present for 6 days. The patient had a history of excessive smoking (60 cigarettes/day). The medical history was otherwise unremarkable. A transient rash had occurred during work 2 weeks previously. The patient could not remember a bite. The electrocardiogram showed 2:1 atrioventricular (AV) block with narrow QRS complexes. D‑dimer and C‑reactive protein were slightly elevated; all other laboratory findings were within normal range. Echocardiography revealed normal findings. ELISA and western blot analysis confirmed acute Lyme disease. Cardiac magnetic resonance imaging (MRI) disclosed myocardial edema in the interventricular septum. Antibiotic treatment with ceftriaxone was initiated for 2 weeks. The heart block improved to a first degree AV block (PR interval 274 ms) at day 5 of treatment. At discharge, the patient had a normal PR interval of 190 ms. Follow-up cardiac MRI revealed almost complete regression of the cardiac septal edema.. Ein 34-jähriger Straßenbauer stellte sich wegen einer seit 6 Tagen bestehenden progredienten Dyspnoe in unserer Notaufnahme vor. Außer einem Nikotinkonsum von 60 Zigaretten pro Tag war die Anamnese unauffällig. Vierzehn Tage zuvor war ein flüchtiges generalisiertes Exanthem bei der Arbeit aufgetreten. Ein Insektenstich war nicht erinnerlich. Das Elektrokardiogramm zeigte einen 2:1-atrioventrikulären (AV) Block mit schmalen QRS-Komplexen. Laborchemisch bestand eine geringe Erhöhung von D‑Dimer und C‑reaktivem Protein. Alle übrigen Parameter waren im Normbereich. Die transthorakale Echokardiographie zeigte einen Normalbefund. Die mikrobiologische Untersuchung bestätigte eine akute Lyme-Borreliose im „enzyme-linked immunosorbent assay“ (ELISA) und Western Blot. Die kardiale Magnetresonanztomographie (MRT) zeigte ein myokardiales Ödem des interventrikulären Septums. Es erfolgte eine 14-tägige antibiotische Therapie mit Ceftriaxon. Hierunter bildete sich der AV-Block am Tag 5 in einen AV-Block ersten Grades mit einer PQ-Zeit von 274 ms zurück. Am Entlassungstag war die PQ-Zeit mit 190 ms im Normbereich. Die Kontroll-MRT zeigte eine nahezu komplette Rückbildung des myokardialen Ödems.

Topics: Adult; Atrioventricular Block; Ceftriaxone; Edema; Electrocardiography; Humans; Lyme Disease; Myocarditis

BACKGROUND Lyme borreliosis, caused by spirochetes of the Borrelia burgdorferi genospecies complex, is the most commonly reported tickborne infection in North America and those infected may present with cutaneous, cardiac, articular, and neuropsychiatric abnormalities. The protean nature of many of its clinical manifestations presents a diagnostic conundrum. Lyme disease can affect the heart, albeit rarely, with cardiac abnormalities usually manifesting as varying degrees of heart block or arrhythmias. CASE REPORT We present a case of complete heart block in a young man who participated in outdoor activities in a Lyme-endemic area and developed fatigue and palpitations weeks after a flu-like illness. He noticed that his heart rate was low; he had an intermediate suspicious index in Lyme carditis (SILC) score with positive Lyme serologies. His initial electrocardiogram when he presented to the emergency department showed a complete heart block. In this case, he was successfully managed with intravenous ceftriaxone, amoxicillin, and a transcutaneous pacemaker, obviating the need for a permanent pacemaker. CONCLUSIONS Electrocardiographic changes such as heart block and arrhythmias with or without symptoms may be the initial manifestation of Lyme carditis in a patient who may or may not remember a tick bite or have a typical skin rash. The SILC score may assist in recognizing these cases and prompt initiation of antibiotics usually leads to the resolution of these electrocardiographic abnormalities and symptoms that may be present.

Topics: Atrioventricular Block; Ceftriaxone; Electrocardiography; Humans; Lyme Disease; Male; Myocarditis

A 39-year-old male patient presented with dyspnea and palpitations. The electrocardiogram (ECG) showed a first degree atrioventricular (AV) block and frequent atrial extra systoles. Within the following 48 h the AV block gradually developed into a third degree intermittent complete AV block. The patient history included an untreated tick bite 2 months before presentation. The serological proof of antibodies confirmed the diagnosis of Lyme carditis and antibiotic treatment with ceftriaxon i.v. was initiated. Normal AV conduction finally resumed and the symptoms subsided completely without any further clinical consequences.. Das Elektrokardiogramm eines 39-Jährigen, der sich mit Kurzatmigkeit und Herzstolpern vorstellt, zeigt einen atrioventrikulären (AV) Block ersten Grades und häufige atriale Extrasystolen. Innerhalb von 2 Tagen kommt es zu einer schrittweisen Progredienz bis hin zum AV-Block dritten Grades. Ein Zeckenbiss des Patienten 2 Monate zuvor war unbehandelt geblieben. Erhöhte Borrelientiter bestätigen die Verdachtsdiagnose einer Lyme-Karditis. Unter antibiotischer Therapie entwickelt sich die AV-Blockierung vollständig zurück.

Topics: Adult; Atrioventricular Block; Ceftriaxone; Dyspnea; Electrocardiography; Humans; Lyme Disease; Male; Myocarditis

Tick-borne diseases, including Lyme disease, are becoming increasingly common in Europe. Lyme disease has a wide variety of clinical manifestations, as a result of which physicians of diverse disciplines are coming into contact with such patients.. A 58-year-old man was seen at the emergency room with a symptomatic Wenckebach-type second-degree atrioventricular (AV) block and periods of 2:1 AV block. Four weeks previously the patient had noticed a red skin lesion on his left lower leg. Under the working diagnosis of early disseminated Lyme disease with cardiac involvement, treatment with ceftriaxone was started. This diagnosis was supported by a positive Borrelia PCR and culture of a skin biopsy and positive Borreliaserology. The AV conduction disorders resolved completely after 2 weeks of treatment with antibiotics and it was not necessary to implant a pacemaker.. A Borrelia infection is a reversible but rare cause of AV conduction disorders. In the event of sudden onset of symptoms or a severe or progressive AV conduction disorder, Lyme carditis should be considered, especially if the medical history or physical examination provides clues for Lyme disease.

Topics: Anti-Bacterial Agents; Atrioventricular Block; Borrelia burgdorferi; Ceftriaxone; Europe; Humans; Lyme Disease; Male; Middle Aged; Pacemaker, Artificial

Topics: Atrioventricular Block; Borrelia burgdorferi; Ceftriaxone; Electrocardiography; Emergency Service, Hospital; Humans; Lyme Disease; Male; Pacemaker, Artificial; Syncope; Treatment Outcome; Young Adult

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Atrial Fibrillation; Atrioventricular Block; Blotting, Western; Ceftriaxone; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Rare Diseases; Syncope; Treatment Outcome

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy-reverted to normal sinus rhythm and discharged home. He returned a few days later-this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Atrial Fibrillation; Atrioventricular Block; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Humans; Lyme Disease; Male; Treatment Outcome; Young Adult

Canada has seen a sixfold increase in Lyme disease since being nationally notifiable in 2009. This is the first Canadian series on Lyme carditis manifested as high-degree atrioventricular block. We report 5 recent cases presented over a 2-year period. The variation of nonspecific presentations requires a high index of suspicion for prompt diagnosis and correct management. Recognizing this early would curtail the progression of conduction disorders and potentially avoid permanent pacemaker implantation.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Atrioventricular Block; Canada; Ceftriaxone; Doxycycline; Echocardiography; Electrocardiography; Erythema Chronicum Migrans; Exercise Test; Humans; Lyme Disease; Male; Myocarditis; Severity of Illness Index; Tick Bites; Young Adult

Topics: Adult; Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Cystic Fibrosis; Endocarditis, Bacterial; Humans; Lung Transplantation; Lyme Disease; Male; Mitral Valve; Tricuspid Valve

Lyme borreliosis is a disease commonly found in humans. Here we report the case of a young, healthy girl presenting with symptomatic first- and second-degree atrioventricular blocks secondary to cardiac myocarditis. The disappearance of the conduction anomaly after antibiotic treatment confirmed Lyme disease before the results from the serology. Therefore, when a healthy, young person suddenly presents with an atrioventricular conduction block, physicians should consider a diagnosis of Lyme disease.

Topics: Adolescent; Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Electrocardiography; Emergency Service, Hospital; Female; Humans; Lyme Disease; Remission Induction

We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.

Topics: Anti-Bacterial Agents; Atrioventricular Block; Azithromycin; Ceftriaxone; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Pacemaker, Artificial

Lyme disease is a tick-borne spirochetal infection that may affect the heart. Cardiac manifestations include conduction disturbances and other pathologies of the heart. We report on a 37-year old male, who was admitted to the emergency department because of dizziness and generalized tiredness. Physical examination and the initial laboratory values revealed no abnormalities. The patient's electrocardiogram on admission revealed newly diagnosed bradycardia due to atrioventricular heart block. The ventricular heart rate was 35/min. The patient was admitted to the ICU. Lyme serology and Western blot were positive for Borrelia antibodies. After institution of antibiotic therapy with ceftriaxone, atrioventricular heart block resolved rapidly. We therefore have to assume that in this patient Lyme carditis was the cause of third-degree AV block.

Topics: Adult; Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Diagnosis, Differential; Humans; Lyme Disease; Male; Myocarditis; Treatment Outcome

Topics: Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Child; Diagnosis, Differential; Electrocardiography; Humans; Lyme Disease; Male

A 54-year-old American woman presented with an episode of syncope. This had occurred against a background of several days of dizziness and palpitations. Her medical history included Bell's palsy, which had been diagnosed three weeks earlier. On examination, she had a resting bradycardia of 31 beats per minute and her electrocardiogram demonstrated third-degree atrioventricular (AV) block. She was referred to cardiology for consideration of permanent pacemaker implantation. Given her facial nerve palsy and AV block, a diagnosis of Lyme borreliosis was suspected. Within 48 hours of initiation of ceftriaxone, she reverted to sinus rhythm, albeit with a marked first-degree AV block. Subsequent serology confirmed the diagnosis. Reversible causes of complete AV block should always be considered and appropriate therapy may avoid the need for permanent pacemaker insertion.

Topics: Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Female; Humans; Lyme Disease; Middle Aged; Myocarditis

PAST HISTORY AND PHYSICAL EXAMINATION: A 38-year-old farmer presented at his general practitioner with dizziness. Physical examination was notable for a heart rate of 35 beats/min. The electrocardiogram (ECG) showed a complete (third degree) heart block with a bradycardic ventricular escape rhythm. The patient reported having had an rash on his right lower leg six weeks previously. After spreading centrifugally it had turned pale in its centre, then regressed and finally disappeared. After having been supplied with a temporary pacemaker in a county hospital the patient was transferred to our hospital.. The ECG showed pacemaker stimulation of the ventricle at about 60 beats/min. Without this stimulation the complete atrioventricular block persisted. Coronary heart disease was excluded by angiography and levocardiography revealed normal systolic left ventricular function. Serological findings were a positive titre of IgG-antibodies against Borrelia while the IgM titre was negative.. The heart block disappeared under antibiotic therapy with ceftriaxon within eight days, after first changing to transitory second and first-degree atrioventricular block, and the pacemaker was removed. The patient did not develop any neurological symptoms.. Cardiac involvement in Lyme disease can be the only manifestation of borreliosis. Possible reversibility under antibiotic therapy is an important aspect of diagnosis. In spite of atypical serology the combination of history, symptoms and serological findings will lead to the diagnosis Lyme disease.

Topics: Adult; Agricultural Workers' Diseases; Anti-Bacterial Agents; Antibodies, Bacterial; Atrioventricular Block; Borrelia burgdorferi; Ceftriaxone; Coronary Angiography; Coronary Disease; Diagnosis, Differential; Electrocardiography; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Disease; Male; Pacemaker, Artificial