Lyme carditis with complex arrhythmia and conduction disorders

Introduction: Lyme borreliosis is a tick-bite transmitted disease with important neurologic and cardiac manifestations. We report a case of Lyme carditis in a 28 year old male, who presented with atypical chest pain, palpitations, dizziness and fatigue. The patient, a heavy smoker, without known history of cardiovascular disease, had intermittent sino-atrial exit block, third-degree atrioventricular block, and episodes of atrial tachycardia. Methods: All laboratory determinations, the chest Xray and echocardiography were within normal ranges. At repeated history taking, the patient remembered that he experienced multiple insect bites a few months ago, during summer. Two weeks before his admission he had an acute artitis of the left hip, that resolved with ibuprofen treatment Results: After excluding coronary disease and myocarditis, antibodies against Borrelia Burgdorferi were requested and they were positive. The cardiac rhythm abnormalities resolved completely after the patient was administered antibiotic. No temporary cardiac pacemaker or antiarrhythmic medication was necessary. Conclusions: Familiarity of both the clinician and the patient with this condition, as well as with adequate serology testing, can lead to a definite diagnosis and prevent a fatal outcome, as well as unnecessary implantĀ of a permanent cardiac pacemaker in a young patient, with a reversible heart disease.

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