Grella Brittney A, Patel Mihir, Tadepalli Satish, Bader Christopher W, Kronhaus Kenneth
Family Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA.
Internal Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA.
Cureus. 2019 Sep 2;11(9):e5554. doi: 10.7759/cureus.5554.
Lyme carditis is a rare cardiac manifestation of Lyme disease that occurs when bacterial spirochetes infect the pericardium or myocardium triggering an inflammatory response. The most common electrocardiogram (EKG) findings in these patients include atrioventricular (AV) conduction abnormalities (first, second, and third degree heart block). A 56-year-old male with a history of hypothyroidism, from the Northeastern region of the United States, presented to the emergency department with lightheadedness and chest pain. His EKG revealed sinus bradycardia with a heart rate of 49 beats per minute, without ST segment elevation, T wave inversions, or signs of heart block. An enzyme-linked immunosorbent assay (ELISA) Lyme titer was elevated, and confirmatory Western blot was positive for IgG and negative for IgM. He was treated with intravenous (IV) ceftriaxone; however, he continued to have persistent bradycardia with his heart rate dropping to 20 to 30 beats per minute throughout the night. Additionally, he had several sinus pauses while sleeping, with the longest lasting for 6.1 seconds. A pacemaker and an additional three-week course of IV ceftriaxone was determined to be the best treatment for his resistant bradycardia secondary to Lyme carditis. No symptoms were present at his one month follow-up appointment, as an outpatient, after completing ceftriaxone therapy. The patient follows up with cardiology regularly to have his pacemaker checked. Here we present a unique case of Lyme carditis, without the classical findings of Lyme disease or common EKG findings of AV conduction abnormalities. A high clinical suspicion of Lyme carditis is required when someone from a Lyme endemic region presents with unexplained cardiac symptoms and electrocardiogram abnormalities. This case report aims to add to the knowledge gap between suspicion of Lyme carditis and sinus bradycardia as the only presenting symptom.
莱姆病性心肌炎是莱姆病罕见的心脏表现，当细菌螺旋体感染心包或心肌引发炎症反应时就会出现。这些患者最常见的心电图（EKG）表现包括房室（AV）传导异常（一度、二度和三度心脏传导阻滞）。一名来自美国东北部地区、有甲状腺功能减退病史的56岁男性因头晕和胸痛就诊于急诊科。他的心电图显示窦性心动过缓，心率为每分钟49次，无ST段抬高、T波倒置或心脏传导阻滞迹象。酶联免疫吸附测定（ELISA）莱姆滴度升高，确诊的免疫印迹法显示IgG阳性、IgM阴性。他接受了静脉注射头孢曲松治疗；然而，他仍持续心动过缓，夜间心率降至每分钟20至30次。此外，他睡觉时出现多次窦性停搏，最长持续6.1秒。对于他因莱姆病性心肌炎导致的难治性心动过缓，确定植入起搏器并再进行为期三周的静脉注射头孢曲松治疗是最佳治疗方案。完成头孢曲松治疗后，他作为门诊患者在一个月的随访预约中没有出现任何症状。该患者定期到心脏病科复诊以检查起搏器。我们在此呈现一例独特的莱姆病性心肌炎病例，没有莱姆病的典型表现或房室传导异常的常见心电图表现。当来自莱姆病流行地区的人出现无法解释的心脏症状和心电图异常时，需要高度怀疑莱姆病性心肌炎。本病例报告旨在填补对莱姆病性心肌炎的怀疑与仅以窦性心动过缓为唯一表现症状之间的知识空白。
