ro13-9904 and Myocarditis

A case is reported of a 27-year-old man who presented to an inner city trauma center after he had experienced several seizure-like episodes. He was diagnosed with Lyme carditis and required 6 weeks of treatment with intravenous ceftriaxone for complete resolution of his symptoms. The case is discussed along with a review of the literature.

Topics: Adult; Anti-Bacterial Agents; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; Diagnosis, Differential; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Disease; Male; Myocarditis; Trauma Centers

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

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

Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest.. A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120-200 ms). Physical exam was unremarkable. The cardiologist's initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor.. Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.

Topics: Adult; Anti-Bacterial Agents; Bradycardia; Ceftriaxone; Death, Sudden; Doxycycline; Exercise; Exercise Test; Heart Block; Heart Rate; Humans; Lyme Disease; Male; Myocarditis

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

Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 7 days of hospitalization. A 15-year-old girl presented with headache, fever, body ache for 1 day and few ecchymotic rash over her body for 3 hours. Blood cultures confirmed infection with N. meningitidis. After 2 days in the hospital, the patient developed dyspnea, elevated jugular venous pressure and shock. The patient was managed with intravenous ceftriaxone, furosemide and norepinephrine. Over the next 4 days the patient rapidly improved. Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient's rapid recovery from myocarditis.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diuretics; Female; Fever; Furosemide; Humans; Male; Meningococcal Infections; Myocarditis; Neisseria meningitidis; Norepinephrine; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; DNA, Bacterial; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Heart; Humans; India; Leptospira; Leptospirosis; Male; Myocarditis; Polymerase Chain Reaction; Radiography; Tachycardia, Sinus; Thorax; Travel-Related Illness; Treatment Outcome

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Meningococcal Infections; Myocarditis; Neisseria meningitidis; Purpura Fulminans; Sepsis; Tachycardia

We report the first adult case of Neisseria meningitidis W-135 presenting with meningococcal arthritis and myopericarditis concomitantly, without other classical features of meningococcal disease.. A 67-year-old Caucasian man presented with acute-onset polyarthralgia, myalgia, and fever. On examination he had polyarticular synovitis. An electrocardiogram (ECG) demonstrated ST-elevation in leads I, II, III, aVF, and V2-V6 without reciprocal depression, and a high-sensitivity troponin level was significantly elevated. Cardiac magnetic resonance (CMR) imaging on day five of admission demonstrated patchy pericardial enhancement. Neisseria meningitidis W-135 was isolated from both synovial fluid and blood cultures. The clinical outcome was favourable with intravenous ceftriaxone and myopericarditis treatment (colchicine and ibuprofen).. We conclude that this is a rare case of disseminated Neisseria meningitidis W-135 presenting with acute polyarticular septic arthritis and myopericarditis, without other classical features of systemic meningococcal disease. The earlier described entity of primary meningococcal arthritis (PMA) can present in patients with meningococcal bacteraemia, and may not be distinct from disseminated meningococcal disease, but rather an atypical presentation of this.

Topics: Aged; Arthritis, Infectious; Blood Culture; Ceftriaxone; Electrocardiography; Humans; Magnetic Resonance Imaging, Cine; Male; Meningitis, Meningococcal; Myocarditis; Neisseria meningitidis; Synovial Fluid

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

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Humans; Leptospirosis; Magnetic Resonance Imaging; Male; Middle Aged; Myocarditis; Pancreatitis

Topics: Anti-Bacterial Agents; Ceftriaxone; Electrocardiography; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Syncope; Treatment Outcome; Young Adult

A 20-year-old Caucasian male patient presented after a single episode of syncope. His heart rate was 40 beats per minute. ECG showed new onset complete heart block. A temporary pacer was placed. He had a macular rash on the body from past 2 weeks and was diagnosed with contact dermatitis. Erythema migrans was considered as differential for rash. Lyme titre was ordered and found to be positive. After antibiotic therapy and observation on telemetry, his heart block resolved. He was subsequently discharged and a follow-up ECG revealed persistent normal sinus rhythm.

Topics: Anti-Bacterial Agents; Bradycardia; Ceftriaxone; Electrocardiography; Erythema Chronicum Migrans; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Pacemaker, Artificial; Syncope; Treatment Outcome; Young Adult

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

Myocarditis typically presents with non-specific clinical symptoms, and can easily be missed in the absence of a high index of clinical suspicion. Myocarditis caused by bacterial pathogens is rare in immunocompetent individuals, more commonly seen following viral infection. Although more classically associated with typhoid fever and gastroenteritis, Salmonella species are a rare cause of myocarditis. We report a case of Salmonella enteritidis-induced myocarditis after gastrointestinal infection in a 16 year-old girl, and discuss the diagnostic tools currently utilised to ascertain the diagnosis.

Topics: Adolescent; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Gastroenteritis; Humans; Myocarditis; Pulmonary Edema; Salmonella enteritidis; Salmonella Food Poisoning; Salmonella Infections; Tachycardia

A 3-year-old girl presented with fatigue, fever, and rash. Tachycardia was noted and an ECG showed junctional tachycardia. Lyme titers were positive and the arrhythmia resolved with intravenous ceftriaxone.

Topics: Anti-Bacterial Agents; Catheterization, Central Venous; Ceftriaxone; Child, Preschool; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Humans; Lyme Disease; Myocarditis; Signal Processing, Computer-Assisted; Tachycardia, Ectopic Junctional

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

Myocarditis is defined clinically as inflammation of the heart muscle, which can be caused by infectious agents, toxins or immunologic reactions. Most recognized cases of acute myocarditis are secondary to cardiotropic viral infections. Escherichia coli rarely cause myocarditis. The authors report a 25-year-old woman with E coli-induced acute pyelonephritis and septic shock that was complicated with acute myocarditis. Her symptoms mimicked acute myocardial infarction. The authors discuss the possible mechanism of bacterial sepsis-induced myocarditis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Escherichia coli Infections; False Positive Reactions; Female; Humans; Myocardial Infarction; Myocarditis; Pyelonephritis; Shock, Septic; Urinary Tract Infections

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

Lyme borreliosis is a multi-system infectious disease that primarily affects the skin, nervous system, heart, and joints. It is caused by the tick-borne spirochete Borrelia burgdorferi sensu lato. Diagnosis is made on the basis of clinical symptoms and supported by a positive serology. Antibiotic therapy should be started immediately after the diagnosis has been established and is administered according to stage and symptoms of the disease. Doxycycline, amoxicillin, and ceftriaxone are the antibiotics of choice. Early Lyme disease is almost always cured by one antibiotic course that also prevents subsequent disease manifestations. After antibiotic therapy of late disease manifestations, symptoms resolve only slowly and remission is usually achieved after weeks or even months. Chronic or therapy-resistant disease courses and residual symptoms after therapy are rare.

Topics: Amoxicillin; Anti-Bacterial Agents; Borrelia burgdorferi Group; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Doxycycline; Endemic Diseases; Follow-Up Studies; Humans; Lyme Disease; Lyme Neuroborreliosis; Myocarditis; Prognosis

The mortality and morbidity of salmonella infections is seriously underestimated. Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days. Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure, features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Multiple Organ Failure; Myocarditis; Pulmonary Edema; Rhabdomyolysis; Salmonella typhi; Treatment Outcome; Typhoid Fever

A 42-year-old German woman presented in hospital with a high temperature (40 degrees C) after visiting Pakistan. She had manifest psychomotor retardation but no signs of meningitis, bradycardia and some pale circular erythematous skin lesions on the abdomen, which disappeared on pressure.. The C-reactive protein (CRP) was 39.27 mg/dl, but the white cell count was normal. Screening tests for malaria were negative, but the blood culture grew Salmonella typhi.. As typhoid fever was suspected and finally confirmed, the patient was treated with oral ciprofloxacin for 14 days. Four days after admission she had to be resuscitated, although the CRP had fallen. The underlying course of the disease was an acute myocarditis with pulmonary edema. Under intensive care complete regression of symptoms was achieved within six days. But after the antibiotic therapy had been completed the patient developed a typhoid relapse with similar but less pronounced signs and symptoms. The antibiotic treatment was changed to ceftriaxon for 14 days and complete remission of clinical, chemical and echocardiographic findings was achieved.. Symptoms of high fever after visiting countries with sometimes poor hygiene should make one suspect typhoid fever, particularly when bradycardia and a normal leukocyte cell count are documented. Because of the pathophysiology of this infection different systemic complications are possible, such as acute myocarditis. Relapses are also a frequent problem: they may occur despite antibiotic treatment given according to the results of microbiological tests.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Anti-Infective Agents; C-Reactive Protein; Ceftriaxone; Ciprofloxacin; Female; Humans; Myocarditis; Pakistan; Pulmonary Edema; Recurrence; Salmonella typhi; Travel; Treatment Outcome; Typhoid Fever

Borreliosis is a multisystemic disease transmitted by ticks. Its diagnosis still remains a challenge because of the varied clinical picture and of difficulties in detection of the etiological agent (Borrelia burgdorferi). We report a case of a 53-years-old woman admitted to the Clinic of Cardiology due to life-threatening arhythmias with simultaneous deficits in concentration and memory. A suspicion of borreliosis was driven from the presence of cardiac symptoms as well as of psychiatric and from the case histories of a tick bite. The diagnosis was confirmed both by specific serological test and endomyocardial biopsy which revealed spirochetes. The patient responded to treatment with doxycyclin and ceftriaxone. Cardiologic disorders retreated entirely, while cognitive deficits did only partly.

Topics: Arrhythmias, Cardiac; Biopsy; Borrelia burgdorferi; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Heart; Humans; Lyme Disease; Memory Disorders; Mental Disorders; Middle Aged; Myocarditis; Myocardium; Serologic Tests

Lyme borreliosis (LB) is the most common tick-born disease in the Northern Hemisphere. During early disseminated Lyme disease cardiac manifestation can occur. We report a case of isolated Lyme myocarditis with transitory total atrioventricular (AV)-block and myocardial necrosis indicated by a rise in Troponin-T (TNT). Antibiotic treatment resulted in complete resolution of the AV-block, but a local epimyocardial contrast enhancement persisted as shown by cardiac magnetic resonance imaging (MRI).

Topics: Adult; Ceftriaxone; Electrocardiography; Follow-Up Studies; Heart Block; Humans; Lyme Disease; Magnetic Resonance Imaging; Male; Myocarditis; Risk Assessment; Severity of Illness Index; Treatment Outcome

A 40-year-old man was referred to the cardiology outpatient clinic with dizziness, palpitations and shortness of breath. He remembered being bitten by a tick two to three years previously, but had not noticed a characteristic skin rash. The ECG showed a prominent first degree atrioventricular (AV) block and ambulatory electrocardiographic monitoring showed an intermittent complete AV block. A definitive pacemaker was implanted. Antibodies to Borrelia were found. The patient was treated with ceftriaxone. In the weeks and months following implantation, the AV block disappeared completely. The reversibility of the AV block secured the diagnosis 'Lyme carditis with secondary AV block', and the pacemaker was explanted.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Electrocardiography, Ambulatory; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Pacemaker, Artificial; Treatment Outcome

Lyme carditis is becoming a more frequent complication of Lyme disease, primarily due to the increasing incidence of this disease in the United States. Cardiovascular manifestations of Lyme disease often occur within 21 days of exposure and include fluctuating degrees of atrioventricular (AV) block, acute myopericarditis or mild left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis. AV block can vary from first-, second-, third-degree heart block, to junctional rhythm and asystolic pauses. Patients with suspected or known Lyme disease presenting with cardiac symptoms, or patients in an endemic area presenting with cardiac symptoms with no other cardiac risk factors should have a screening electrocardiogram along with Lyme titers. We present a case of third-degree AV block due to Lyme carditis, illustrating one of the cardiac complications of Lyme disease. This disease is usually self-limiting when treated appropriately with antibiotics, and does not require permanent cardiac pacing.

Topics: Ceftriaxone; Drug Therapy, Combination; Electrocardiography; Female; Follow-Up Studies; Heart Block; Humans; Infusions, Intravenous; Lyme Disease; Middle Aged; Myocarditis; Prednisone; Risk Assessment; Severity of Illness Index; Treatment Outcome

A case of Lyme myocarditis manifest as a fascicular tachycardia is presented. Subtle findings of heart block in the presence of preserved ventricular function led to the correct diagnosis in this otherwise healthy patient. Treatment with ceftriaxone resolved both abnormalities.

Topics: Adult; Bundle-Branch Block; Ceftriaxone; Cephalosporins; Electrocardiography; Humans; Lyme Disease; Male; Myocarditis; Tachycardia

Lyme disease is a recognised cause of atrioventricular block. In most cases the conduction disturbances are reversed by treatment with antibiotics. A 44 year old man with third degree atrioventricular block in Lyme carditis had a temporary decrease in heart rate during resolution of the heart block two days after treatment with antibiotics was started.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Electrocardiography; Heart Block; Heart Rate; Humans; Lyme Disease; Male; Myocarditis

A 23-year old patient suffered from transient oligoarthritis and second degree AV block. The diagnosis of stage II systemic Lyme borreliosis was supported by a history of tick bites and the detection of both IgG and IgM borrelia antibodies in the patient's serum. The ECG-findings (bradyarrhythmia and AV block II) were detected several weeks after the onset of arthritis, whilst the patient reported no cardiac symptoms. Treatment was started with ceftriaxone and then continued with doxycycline because of an allergic reaction to the first antibiotic.

Topics: Adult; Antibodies, Bacterial; Arthritis, Reactive; Borrelia burgdorferi Group; Ceftriaxone; Diagnosis, Differential; Doxycycline; Electrocardiography; Heart Block; Humans; Immunoglobulin M; Infusions, Intravenous; Lyme Disease; Male; Myocarditis