Department of Medicine, Drexel University College of Medicine & Hahnemann University Hospital, 245 N.15th Street, Philadelphia, PA 19102,
Scott Med J. 2013 May;58(2):e13-7. doi: 10.1177/0036933013482661.
It is rare to see heart block as the first-and-only presentation of Lyme disease, the reported incidence being just 1% in untreated patients.
We report a patient who presented with syncope secondary to a fluctuating heart block. He had no previous manifestations of Lyme disease. Lyme carditis was suspected after the other usual etiologies of heart block were ruled out. Later, serologies came positive and patient's heart block resolved on ceftriaxone therapy.
In at-risk individuals, clinicians should rule out this readily-treatable cause of heart block before proceeding with permanent pacemaker implantation due to enormous clinical and cost implications involved. Missing the diagnosis also exposes the patient to the risk of developing the late complications of Lyme disease. Diagnosis of isolated Lyme carditis is a challenge because the clinician does not have the diagnostic-clues that can usually be gleaned from the more common stigmata of Lyme disease.
作为莱姆病的首发且唯一表现，心脏传导阻滞十分罕见，未经治疗的患者中报告的发病率仅为 1%。
我们报告了一例因波动性心脏传导阻滞导致晕厥的患者。他以前没有莱姆病的表现。在排除其他常见的心脏传导阻滞病因后，怀疑为莱姆心炎。随后，血清学检查阳性，患者的心脏传导阻滞在头孢曲松治疗后得到缓解。
在高危人群中，由于涉及巨大的临床和成本影响，在进行永久性起搏器植入之前，临床医生应排除这种易于治疗的心脏传导阻滞病因。漏诊还使患者面临莱姆病晚期并发症的风险。孤立性莱姆心炎的诊断具有挑战性，因为临床医生没有通常可以从更常见的莱姆病特征中获得的诊断线索。
