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Lyme Carditis


Presentation

  • We present a case report of 46-year-old man with no medical history, who complained of extreme fatigue, near-syncope, and palpitations. He initially presented in complete heart block.[ncbi.nlm.nih.gov]
Malaise
  • We describe the case of a 37-year-old Caucasian man with a 1-month history of fevers, rash, and malaise who died unexpectedly on the day after he underwent medical evaluation.[ncbi.nlm.nih.gov]
  • The primary symptoms of stage 2 include intermittent arthritis, cranial nerve palsies and radicular symptoms, atrioventricular (AV) nodal block, and severe malaise and fatigue.[empirestatelymediseaseassociation.org]
  • Summary: A 55-year-old man with progressively worsening generalized malaise, flu-like symptoms, dyspnea on exertion, and near syncope was admitted with bradycardia (heart rate was between 20 and 30 beats per minute upon admission).[journals.sagepub.com]
  • Variable Value Age 50 years 1 Male 1 Outdoor activity/endemic area 1 Constitutional symptoms* 2 Tick bite 3 Erythema migrans rash 4 * fever, malaise, arthralgia, and dyspnea Patients with high-degree heart block and a SILC score of three or higher should[lymedisease.org]
  • Snapshot A 16-year-old boy presents to his primary care physician with fatigue, malaise, and a rash. His symptoms began approximately 1 week ago and have progressively worsened.[medbullets.com]
Regurgitation
  • This case of a 59-year-old man with Lyme carditis demonstrates the unique presentation of widespread conduction system disease, mitral regurgitation, and suspected ischemic disease.[ncbi.nlm.nih.gov]
  • His echocardiograms showed mild mitral and aortic valvular regurgitation, but no other abnormalities. View larger version (27K) Fig. 1.[thij.org]
  • The echocardiogram revealed normal ejection fraction with mild mitral regurgitation and mildly dilated left atrium. During his first week of hospitalization the patient remained symptomatic with spells of dizziness.[innovationsincrm.com]
Chest Pain
  • We report a case of Lyme carditis in an otherwise healthy male, who presented to the Accident & Emergency Department with chest pain, dizziness and generally symptoms indicating ischaemic heart disease.[ncbi.nlm.nih.gov]
  • Also, heart failure and chest pains are known to occur. Heart problems caused by Lyme disease are rare Heart problems caused by Lyme disease don’t often happen, and therefore, are difficult to recognize by doctors.[innatoss.com]
  • Patients may experience light-headedness, fainting, shortness of breath, heart palpitations, or chest pain.[cdc.gov]
  • This can cause sharp chest pain that increases with deep breaths or lying down, compared to sitting up. Over time the pericardium can thicken and adhere to the heart muscle.[everydayhealth.com]
Pericardial Friction Rub
  • In the original description of 20 patients with Lyme carditis (1) one patient had a pericardial friction rub on auscultation and another had a small pericardial effusion.[rwjms1.umdnj.edu]
Joint Effusion
  • effusions knee and shoulder recurrent acrodermatitis chronica atrophicans "cigarette paper" skin dorsum of hands, feet, knees, elbows in older patients Studies Serum labs WBC normal or elevated ESR, CRP elevated ELISA (sensitive, not specific) 2 steps[orthobullets.com]
Oligoarthritis
  • Abstract Lyme disease has been recognized in humans since 1975 when it was associated with an outbreak of oligoarthritis in children in Lyme, Connecticut.[ncbi.nlm.nih.gov]

Workup

  • Hopefully, the patient gets to the ER quickly, where the ER doctor would perform a cardiac workup and see an aberrant heart rhythm.[bayarealyme.org]
  • And because of the medical-clinical divide in regard to Lyme disease, insurance covers little to none of her workups and treatment. The disease is debilitating, deflating and downright expensive.[usatoday.com]
Elevated Sedimentation Rate
  • The initial laboratory work, including cellular blood count, cardiac enzymes and electrolytes, was normal except for an elevated sedimentation rate. Echocardiogram findings were normal.[innovationsincrm.com]
Prolonged PR Interval
  • A repeat ECG showed a first-degree AV block with a markedly prolonged PR interval of greater than 400 ms. Physical exam revealed multiple annular, erythematous, macular lesions with central clearing. (Figures 1 and 2.)[journals.lww.com]
  • He was noted to possibly have subtle Brugada pattern on EKG with prolonged PR interval of 252ms. A procainamide challenge was equivocal. He was placed on quinidine for suspected Brugada syndrome.[onlinejacc.org]
Prolonged PR Interval
  • A repeat ECG showed a first-degree AV block with a markedly prolonged PR interval of greater than 400 ms. Physical exam revealed multiple annular, erythematous, macular lesions with central clearing. (Figures 1 and 2.)[journals.lww.com]
  • He was noted to possibly have subtle Brugada pattern on EKG with prolonged PR interval of 252ms. A procainamide challenge was equivocal. He was placed on quinidine for suspected Brugada syndrome.[onlinejacc.org]
Borrelia Burgdorferi
  • The diagnosis of Lyme carditis was confirmed by Borrelia burgdorferi-specific IgM and IgG antibody determinations in consecutive serum samples. All patients were treated with antibiotics.[ncbi.nlm.nih.gov]
Sinus Arrest
  • Twelve hours after presentation, the patient developed severe sinus bradycardia followed by sinus arrest. Administration of atropine followed by emergent transvenous pacemaker restored organ perfusion.[innovationsincrm.com]
Third Degree Atrioventricular Block
  • 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.[ncbi.nlm.nih.gov]
  • B , Telemetry demonstrating regression from third-degree atrioventricular block to polymorphic ventricular tachycardia (VT) as the patient began reporting presyncopal symptoms.[ahajournals.org]
  • atrioventricular block, 28 percent had some form of second- or first-degree atrioventricular block, and 23 percent had no conduction abnormalities. 18 Other less common manifestations include myopericarditis, bundle branch block, and heart failure. 17[aafp.org]
First-Degree Atrioventricular Block
  • He was admitted and over the course of the next few days, his rhythm regressed to Mobitz type I first-degree atrioventricular block and then to normal sinus rhythm.[ncbi.nlm.nih.gov]
  • Laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein, bilateral temporal artery biopsy results were negative and first degree atrioventricular block was seen on electrocardiogram.[pagepress.org]
  • However, they reported that 98% of adults who develop Lyme carditis will develop first degree atrioventricular block, and 58% of those patients are likely to develop complete heart block.[healio.com]
  • atrioventricular block and PR interval greater than 30 milliseconds, as well as for patients with second- or third-degree atrioventricular block Patients with an isolated facial nerve palsy (i.e., normal cerebrospinal fluid examination) can be treated[aafp.org]
Ventricular Hypertrophy
  • Although an echocardiogram was not performed, there was autopsy evidence of left ventricular hypertrophy and focal calcification at the base of his aortic valve.[rwjms1.umdnj.edu]
Cannon A-Waves
  • No pertinent physical findings were noted except for jugular cannon A waves. His blood pressure was 100/60 mmHg with a heart rate of 50 bpm. His electrocardiogram showed a sinus rhythm with third-degree heart block and junctional escape rhythm.[innovationsincrm.com]

Treatment

  • In most cases the conduction disturbances are reversed by treatment with antibiotics.[ncbi.nlm.nih.gov]
  • The progression of Lyme disease can be prevented with proper diagnosis and initial treatment.[pharmacytimes.com]
  • Among these patients, earlier ceftriaxone treatment may have been associated with complete recovery or improved LVEF, but the role of steroids remains unclear. 4 This patient's clinical course and treatment brought to question what caused her disease;[ahajournals.org]

Prognosis

  • This case highlights the importance of timely diagnosis and appropriate management to achieve a favorable prognosis.[ncbi.nlm.nih.gov]
  • The overall prognosis of Lyme carditis seems to be good, although delayed recovery has been described and possible late manifestations have been suggested.[rug.nl]

Etiology

  • Conclusion: Considering Lyme carditis as a differential diagnosis in patients with an AV block of an unknown etiology can result in a timely diagnosis and treatment of Lyme carditis. 1. Forrester, JD, Vakkalanka, JP, Holstege, CP, Mead, PS.[journals.sagepub.com]
  • Borrelia burgdorferi as an etiologic agent in chronic heart failure? Scandinavian journal of infectious diseases.[on-lyme.org]
  • Cardiac evaluation was felt to be beneficial in diagnosing the presence of myocarditis and pericarditis both in symptomatic and asymptomatic children.(9) Lyme Disease has been implicated as a possible etiologic agent in dilated cardiomyopathy.(12,13,14[rwjms1.umdnj.edu]
  • ., carditis) late stage arthritis encephalopathy or polyneuropathy Epidemiology incidence most cases in the northeast and upper midwest Etiology Borrelia burgdorferi, a spirochete transmitted by the Ixodes tick this tick is also a vector for Anaplasma[medbullets.com]
  • Borrelia burgdorferi as an etiologic agent in chronic heart failure. Scand J Infect Dis. 1991; 77 :85–87. [ PubMed ] [ Google Scholar ] 30. Levolas P, Dontas I, Bassiakon E, Xanthos T.[ncbi.nlm.nih.gov]

Epidemiology

  • Auwaerter has assembled a group of expert authors to review the following topics: Epidemiology of Lyme Disease; Early Lyme disease: Erythema Migrans; Neuroborreliosis; Lyme Carditis; Lyme Arthritis; Pediatric Lyme Disease; Diagnostics of Lyme Disease;[books.google.es]
  • Malawista, Erthema chronicum migrans and Lyme arthritis: Epidemiologic evidence of a tick vector, Am J Epidemiol . 108: 312–321 (1978). PubMed Google Scholar 2. A. Rubin, C. Servera, P. Nikitin, A. McAllister, G.P. Wormser, R. B.[link.springer.com]
  • I suspect I was too late to change protocol on this case, but maybe now that I’ve cracked open the door I can go talk with the sheriff and tell him about our local epidemiological study.[lymedisease.org]
  • Epidemiology Lyme borreliosis is the most common tickborne disease in the United States. It is caused by the spirochete Borrelia burgdorferi, and is transmitted by the common deer tick.[journals.lww.com]
Sex distribution
Age distribution

Pathophysiology

  • The exact pathophysiology behind the predominant selection of the cardiac conduction system is unclear since cardiac biopsies are rarely available.[innovationsincrm.com]
  • 1243 Percutaneous Coronary Intervention 1258 Percutaneous Cardiac Procedures 1273 Coronary Artery Bypass Surgery 1290 Approaches to the Patient with Prior Bypass Surgery 1306 Percutaneous Valve Dilatations 1316 Global Pandemic of Heart Failure 1330 Pathophysiology[books.google.es]
  • 8.6 cases/100,000) adults 55-59 (7.8 cases/100,00) geographic locations northeast, midwest, western US (areas with heavy deer population) Maryland to Maine (Ixodes scapularis) Great Lakes region (Ixodes scapularis) Pacific Northwest (Ixodes pacificus) Pathophysiology[orthobullets.com]
  • By distinguishing subsets of Lyme disease, such as PTLDS, our research program is illuminating the pathophysiology of the illness to improve diagnostics, treatments, and quality of life for patients.[hopkinsarthritis.org]
  • Better understanding of disease pathophysiology will enable the development of improved diagnostic tests and therapies.[hopkinsrheumatology.org]

Prevention

  • , Atlanta, Georgia. 2 Bacterial Disease Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia.[ncbi.nlm.nih.gov]
  • The best way to prevent tickborne diseases is to prevent tick bites: PROTECT Avoid areas where ticks live. Use EPA-registered tick repellent on exposed skin. Use permethrin on clothing. Wear pants and long sleeves to keep ticks off your body.[vermontbiz.com]
  • Lyme's carditis may be prevented by starting the antibiotic therapy at the time of the chronic erythema migrans. Upon medication the patient may recover from the carditis without remaining symptoms.[hungary.pure.elsevier.com]

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