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Lyme carditis: complete AV dissociation with episodic asystole presenting as syncope in the emergency department
M E Rosenfeld1, B Beckerman, M F Ward
1Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York 11030, USA.
Insights
A young male experienced sudden fainting and seizure-like activity due to Lyme carditis, a serious heart infection from Lyme disease. Prompt antibiotic treatment with ceftriaxone and pacemaker insertion resolved the severe heart block.
Area of Science:
- Cardiology
- Infectious Diseases
- Neurology
Background:
- Lyme disease is a growing public health concern, particularly in endemic areas.
- Cardiac involvement, known as Lyme carditis, can manifest with various degrees of atrioventricular block.
Observation:
- A previously healthy young male presented with syncope and seizure-like activity.
- The patient acutely developed third-degree atrioventricular (AV) block with asystole, despite no prior history of Lyme disease.
Findings:
- The third-degree AV block and asystole necessitated emergent transvenous pacemaker placement.
- Cardiac function and rhythm normalized following intravenous ceftriaxone treatment, confirming Lyme carditis as the etiology.
Implications:
- This case highlights the potential for severe cardiac manifestations of Lyme disease, even in young, otherwise healthy individuals.
- It underscores the importance of considering Lyme carditis in patients presenting with unexplained syncope, seizures, and high-grade AV block.
- Appropriate screening and timely antibiotic treatment are crucial for managing Lyme carditis and preventing long-term sequelae.
Abstract:
We report a case of Lyme carditis in an otherwise-healthy young male who presented to the Emergency Department (ED) with syncope and a possible seizure. This patient, without documented history of Lyme disease, acutely developed third-degree atrioventricular (AV) block with episodic asystole, which required placement of a transvenous pacemaker in the ED and resolved only after the patient had been placed on ceftriaxone. We discuss the significance of Lyme carditis and its increasing prevalence, and review the current literature. We also recommend appropriate screening modalities for patients with known Lyme disease, or an atypical profile for cardiac abnormalities.