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[Clinical picture of cardioborreliosis: from AV block to perimyocarditis]
Insights
Lyme borreliosis can cause severe heart block and fainting (Adams-Stokes attacks). Prompt antibiotic treatment for this tick-borne illness effectively restored normal heart rhythm in patients.
Area of Science:
- Infectious Diseases
- Cardiology
- Neurology
Context:
- Lyme borreliosis, a tick-borne illness, can present with cardiac manifestations.
- Third-degree atrioventricular (A-V) heart block and Adams-Stokes attacks are serious complications.
Purpose:
- To describe the clinical presentation, diagnosis, and treatment outcomes of patients with Lyme borreliosis presenting with third-degree A-V heart block and Adams-Stokes attacks.
Summary:
- Nine patients with Lyme borreliosis experienced third-degree A-V heart block and severe Adams-Stokes attacks.
- Diagnosis involved clinical findings (including erythema migrans) and positive serologic tests for Borrelia.
- Treatment with antibiotics (penicillin, tetracycline) and supportive care (atropine, isoproterenol, temporary pacing) successfully restored normal sinus rhythm and A-V conduction.
Impact:
- This study highlights that cardiac involvement, specifically severe A-V block, can be a dominant feature of Lyme borreliosis.
- Effective antibiotic therapy can reverse these serious cardiac complications, emphasizing the importance of early diagnosis and treatment.
Abstract:
The third degree A-V heart block with severe Adams-Stokes attacks in nine patients with Lyme borreliosis was described. All patients had similar clinical picture: previously healthy with syncope as abrupt onset of the disease. Data on skin changes--erythema migrans--were obtained subsequently although the patients did not recall being bitten by a tick. Diagnosis was based on clinical manifestation, and on positive serologic tests to Borrelia. After the administered therapy (on admission atropine 0.5 mg i.v., and/or isoproterenol 0.02 mcg/kg/min, temporary pace-maker in two patients; and after proved diagnosis penicillin 20 mil. unit per day 10 days, and tetracyclin 2.0 gr per day 20 days A-V block returned to sinus rhythm with normal A-V conduction, and all biochemical parameters returned to normal limits. Perimyocarditis is not rare during Lyme borreliosis, but in this case infection syndrome is dominant.