Zainal Abir, Hanafi Amir, Nadkarni Ninad, Mubasher Mahmood, Lingutla Deeraj, Hoefen Ryan
Department of Internal Medicine, Unity Hospital, Rochester, New York, USA.
Department of Cardiology, Rochester Regional Health, Rochester, New York, USA.
BMJ Case Rep. 2019 Apr 29;12(4):e228975. doi: 10.1136/bcr-2018-228975.
The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.
美国莱姆病的发病率为每10万例中有8例，其中95%发生在东北地区。未经治疗的患者中仅有1%会出现心脏受累。我们描述了一名46岁男性的病例，他出现胸痛、呼吸困难、心悸和晕厥症状。他最初表现为伴有快速心室反应的心房颤动，这是莱姆心肌炎的一种罕见表现。在另一次住院时，他出现了不同程度的房室传导阻滞，包括莫氏I型二度房室传导阻滞。经过适当的抗生素治疗后，他完全康复，心电图恢复正常。作者旨在敦促在疫区治疗患者的医生，在对心房颤动和不明原因心脏传导阻滞患者进行检查时考虑莱姆心肌炎，因为相关的房室结并发症可能是致命的。
