Naslov
Lyme carditis – a sporadic, but reversible cause of atrioventricular block

Autori
Gjurašin, Branimir ; Ajduković, Mia ; Rakušić, Snježana ; Papić, Neven

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
11th Croatian Congress of Clinical Microbiology and the 8th Croatian Congress for Infectious Diseases - Abstract Book / - , 2016

Skup
11th Croatian Congress of Clinical Microbiology and the 8th Croatian Congress for Infectious Diseases

Mjesto i datum
Poreč, Hrvatska, 20.09.2016. - 23.09.2016

Vrsta sudjelovanja
Poster

Vrsta recenzije
Nije recenziran

Ključne riječi
Lyme carditis, atrioventricular block

Sažetak
Lyme carditis is a rare, but potentially severe manifestation of Borrelia burgdorferi (Bb) infection. Although it usually presents as a atrioventricular (AV) conduction block of varying degree, the occurrence of severe cardiac arrhythmias can lead to sudden cardiac death. Here we present two male patients with no history or cardiac conduction abnormalities that had serologically confirmed exposure to Bb, sudden onset of AV conduction disturbances and a history of recent tick bite. The 26-year-old patient initially presented with erythema chronicum migrans (ECM) which appeared one month ago. Third day of doxycycline therapy, he developed chest pain and dyspnea (NYHA II). His resting electrocardiogram (ECG) revealed a 1st degree AV block (PR 260ms). Cardiac enzymes were within normal range. He was treated with intravenous ceftriaxone for 3 weeks. The heart block reverted to normal rhythm after 48 hours of treatment and 24-hour Holter-EKG was normal post-discharge. The second case was a 46-year-old patient that had an episode of syncope one month after a tick bite. Due to the complete, symptomatic AV block, he underwent emergent permanent pacemaker insertion. Coronary angiogram was normal for age, as well as routine laboratory tests. Two weeks after hospital discharge, he had a new tick bite that raised suspicion on Bb as a cause of AV block, although patient didn’t recall ECM. Serology was positive for IgM and IgG in ELISA and WB. The patient started the outpatient ceftriaxone treatment, and after 3rd dose his ECG showed complete resolution of AV block (PR 180ms, no ES activity). These cases highlight the importance of Lyme carditis as a cause of sudden onset of AV block in Bb endemic areas. Since early antibiotic treatment is associated with rapid resolution of conduction abnormalities, the necessity for permanent pacemaker can be avoided in majority of cases.

Izvorni jezik
Engleski

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