The tick that stopped the ticker

A 31 year old healthy male was brought to emergency department after he collapsed while attending a bingo tournament. He denied any chest pain, shortness of breath or palpitations. The witnesses of event reported no incontinence, tongue bite or jerky movements of body. Patient had no recollection of event and was asymptomatic at presentation. Patient reported being in the woods for last few days and developing malaise and generalized weakness 3days prior to this event. The patient was awake, alert and oriented to time, place and person. His vital signs and cardiovascular examination were unremarkable. His laboratory data revealed a normal cell count, electrolyte panel, thyroid functions and troponin-I. Urine examination was normal. His ECG showed () complete AV dissociation with an accelerated idioventricular rhythm. Atrial rate was roughly hundred and ventricular rate was noted to be 78. Patient was admitted to the Intensive care unit, his repeat ECG showed complete heart block (). Upon diagnosis of complete heart block a temporary transvenous pacemaker was placed. The patient's recent history of being in the woods followed by malaise led to possibility of Lyme disease as etiology of heart block. His Lyme serologies came back positive consistent with current infection. This was confirmed by Western Blot. His ANA, ehrlichiosis panel and peripheral blood smear for parasites were negative. He was diagnosed with Lyme carditis and started on intravenous ceftriaxone. An infectious...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Online Letters to the Editor Source Type: research