Lyme carditis: complete atrioventricular dissociation with need for temporary pacing

Area of Science:

• Cardiology
• Infectious Diseases
• Tick-borne Illnesses

Background:

• Lyme borreliosis is a bacterial infection transmitted by ticks.
• Cardiac involvement (Lyme carditis) is an uncommon but serious manifestation.
• Differential diagnosis of cardiac symptoms often includes ischemic heart disease.

Observation:

• A healthy male presented with chest pain and dizziness, mimicking ischemic heart disease.
• The patient acutely developed third-degree atrioventricular block.
• No prior history of Lyme disease was documented.

Findings:

• Lyme carditis was diagnosed based on the clinical presentation and subsequent response to treatment.
• Third-degree atrioventricular block necessitated temporary transvenous pacemaker placement.
• Intravenous doxycycline administration led to the resolution of the heart block.

Implications:

• This case underscores the importance of considering Lyme carditis in the differential diagnosis of new-onset heart block, especially in endemic areas.
• Early recognition and antibiotic treatment can prevent severe cardiac complications.
• Awareness among emergency department physicians is crucial for timely diagnosis and management of Lyme carditis.