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蜱叮咬所致房室传导阻滞——莱姆病性心肌炎

[Atrioventricular block caused by tick bite--Lyme's carditis].

作者信息

Lörincz I, Várvölgyi C, Lakos A, Wórum F, Kovács P, Polgár P

出版信息

Orv Hetil. 1989 Oct 22;130(43):2311-4.

PMID:2682445
Abstract

The authors present the case of a 44-year-old patient who was admitted to the hospital because of AV block of degree III. Six weeks earlier a tick was removed from the left foot of the patient. Two weeks later an erythema of 8 cm in diameter, spreading peripherally as well as painful inguinal lymphadenitis developed at the site of the bite with transient arthralgia and myalgia in the region of the waist and left lower limb. After the temporary use of pacemaker, steroid and atropine therapy applied because of the pronounced bradycardia the block became of degree I on the 4th day however negative T-waves appeared in leads III, aVF, V3. By the 14th day the AV time returned to normal and the pathological signs of repolarization disappeared. Serological examinations revealed increased Borrelia burgdorferi antibody level. Lyme's carditis may be prevented by starting the antibiotic therapy at the time of the chronic erythema migrans. Upon medication the patient may recover from the carditis without remaining symptoms.

摘要

作者报告了一例44岁因三度房室传导阻滞入院的患者。六周前患者左脚被蜱虫叮咬。两周后,叮咬部位出现直径8厘米的红斑,红斑向周围扩散,并伴有疼痛性腹股沟淋巴结炎,同时腰部和左下肢出现短暂性关节痛和肌痛。因显著心动过缓临时使用起搏器后,应用了类固醇和阿托品治疗,第4天阻滞变为一度,但III、aVF、V3导联出现T波倒置。到第14天,房室传导时间恢复正常,复极的病理征象消失。血清学检查显示伯氏疏螺旋体抗体水平升高。慢性游走性红斑出现时开始抗生素治疗可预防莱姆心肌炎。用药后患者心肌炎可痊愈且不留后遗症。

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