Recognizing Lyme Carditis: A Slow Heart Needing Fast Diagnosis
Only 3-4% of 30 000 cases of Lyme disease reported to the CDC each year involve Lyme Carditis; however, it remains one of the most common causes of acquired advanced AV block in otherwise healthy young or middle-aged adult patients. Proper identification and treatment is essential to prevent progression of the disease into a fatal one. A case of a 39 year old male presenting to the Emergency Department with complaint of painful bilateral lower leg swelling and myalgias for two weeks highlights the importance of identification and treatment. This patient worked as a roofer, denied recent travel or tick bites, but admitted to IV methamphetamine use. His vitals were significant for bradycardia in the 30s. Initial EKG showed third degree heart block. Given the high degree of suspicion for infective endocarditis, TTE was ordered revealing a possible small vegetation on the aortic valve and possible abscess. Meanwhile, lyme serology was pending. Subsequently, a TEE ruled out both endocarditis and an abscess. At this point, Cardiac MRI was ordered to rule out sarcoidosis. The patient remained on empiric antibiotics throughout the hospital admission. Once preliminary lyme serology came back positive, antibiotic therapy was further tailored. The patient clinically improved over the course of several days and serial EKG's revealed improving heart block. Lyme carditis is a treatable disease. Prompt recognition and treatment can prevent disease progression, unnecessary placement of pacemakers, and death.