A Rare Complication of a Common Disease

​BY ANUMEHA SINGH, MD, &ANDREJ KIELTYKA, PASymptomatic bradycardia is usually reserved for the over-the-hill crowd, but it is not entirely unheard of in the young and healthy. A 21-year-old African American man was sent to the emergency department by his primary care provider. The patient had no previous medical issues, normal vital signs, and was fine until about a week prior. He had quickly worsening shortness of breath while climbing the stairs to get to his dorm bedroom. The young man denied having been out in the woods or noting tick bites. He had no family history of cardiomyopathy or early cardiac events.​The patient had negative toxicology and social history screens. When pressed further, he recalled malaise, stiff neck, low-grade temperature, and muscle aches for about two weeks prior to exertional dyspnea onset. As it turned out, he went to a bonfire party for his graduating college class about three weeks before presentation. He thought the malaise was just a cold, and only the exertional component brought him and his mom to his doctor for evaluation.A heart block with a heart rate of 36 bpm was noted on an ECG in the office, which was then compared with the normal sinus rhythm from previous ECGs. The patient was directed to the emergency department for further testing. The patient appeared well, had no advantageous heart sounds, and had an essentially normal exam with no skin rash besides a heart rate of 44 bpm and a third-degree heart block on ECG.The cli...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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