Electrocardiogram as a Lyme Disease Screening Test

To examine the association between electrocardiographic (ECG) evidence of carditis at the time of Lyme disease evaluation and a diagnosis of Lyme disease.
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Original Articles Source Type: research

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Mil Med. 2021 Oct 6:usab420. doi: 10.1093/milmed/usab420. Online ahead of print.ABSTRACTLyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. Our case illustrates an active duty male who was initially diagnosed with Lyme disease after initially reporting symptoms including headache, fever, ey...
Source: Military Medicine - Category: International Medicine & Public Health Authors: Source Type: research
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape.  The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
A 49-year-old healthy woman presented with exertional shortness of breath and palpitations of 3 months ’ duration. Baseline electrocardiogram (ECG) was normal. Figure 1 shows selected tracings recorded during treadmill stress testing. Transthoracic echocardiogram showed no structural abnormalities. Cardiac positron emission tomogram showed normal myocardial perfusion and no abnormal fluorodeoxyglu cose uptake. Antibody titers for Lyme disease were undetectable. Figure 2 shows selected tracings from an invasive electrophysiological (EP) study.
Source: Heart Rhythm - Category: Cardiology Authors: Tags: Scheinman/Peter ECG Corner Source Type: research
Discussion Bradycardia is a heart rate below what the lowest value that is normal for age. Infants and children have higher heart rates that slowly decrease with age to adult levels. It is usually noted as an incidental finding because of increased vagal tone. Reasons for cardiology referral include associated heart murmur, syncope especially if associated with exercise or unusual triggers, other signs such as chest pain or palpitations, family history of sudden cardiac death, congenital heart disease or familial heart disease, bradycardic medication use, or unusual symptoms associated with the concern. Severe bradycardia ...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Written by Pendell Meyers(with really great and thorough explanation of this finding by Ken Grauer).At my hospital, patients with any symptoms which could be vaguely interpreted as a possible stroke during the triage process are brought to the high acuity area and a provider is asked to do a " neuro check " , which involves a quick H and P and exam to determine if we should activate our stroke protocol.A man in his 70s was brought to me for a neuro check, and the triage providers commented that they were worried about a possible seizure as well. The patient was alert and oriented with normal vitals at triage. He ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This was sent by a Saleh Hatem, an avid reader of the blog.The patient presented with chest pain:There is a narrow complex tachycardia.Is there inferior ST Elevation?Here was my interpretation:What appears to be ST Elevation in inferior leads is really a P-wave that is contiguous with the QRS. (The next bump over is a T-wave that looks like a P-wave!).Since the P-wave is not inverted, it is NOT retrograde, and therefore it is a native sinus beat.  This sinus beat does conduct, but there is severely prolonged PR interval (severe first degree AV block), with a PR interval of over 400 ms.So: Sinus tachycardia with severe...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Patient Presentation A 9-year-old male came to clinic with a 1 month history of painful joint swelling. One month ago he started having right ankle pain that was intermittent but consistent. One day ago his right wrist, right ankle and bilateral knees had some swelling but no erythema or warmth. He says that he has pain in them when he moves but not when he is resting and he denies any joint stiffness or gelling. He also had 1-2 days of multiple red skin lesions on his extremities and trunk, not overlying the affected joints. The skin lesions do not come and go and do not itch. They are mainly discrete circular lesions wi...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Lyme carditis is an uncommon manifestation of early disseminated Lyme disease. This case illustrates a 66-year-old male with complaints of fatigue, myalgias, and fever after a tick bite 3days earlier. A large erythema migrans was found on the chest wall. Initial electrocardiogram showed sinus rhythm with second degree 2:1 atrioventricular (AV) block, which progressed to intermittent complete AV block rapidly. He was treated with intravenous ceftriaxone. Over the course of 2-weeks of antibiotic therapy, the intermittent high-grade AV block improved slowly and progressively.
Source: Journal of Electrocardiology - Category: Cardiology Authors: Source Type: research
Lyme carditis is an uncommon manifestation of early disseminated Lyme disease. This case illustrates a 66-year-old male with complaints of fatigue, myalgias, and fever after a tick bite 3days earlier. A large erythema migrans was found on the chest wall. Initial electrocardiogram showed sinus rhythm with second degree 2:1 atrioventricular (AV) block, which progressed to intermittent complete AV block rapidly. He was treated with intravenous ceftriaxone. Over the course of 2-weeks of antibiotic therapy, the intermittent high-grade AV block improved slowly and progressively.
Source: Journal of Electrocardiology - Category: Cardiology Authors: Source Type: research
​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.​Th...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
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