A tick beat in the electrocardiogram: Persistent third degree block as only manifestation of Lyme disease

• Published in: Journal of electrocardiology 2019-01, Vol.52, p.109-111
• Main Authors: Jiménez-Castillo, Raúl Alberto, Carrizales-Sepúlveda, Edgar Francisco, Vera-Pineda, Raymundo, Herrera-Elizondo, José Luis, García-Sarreón, Alexis, Reyes-Mondragón, Alan Ledif, Mercado-Domínguez, Elizabeth, Marfil-Rivera, Luis Javier
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Arachnids; Atrioventricular Block - diagnosis; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Bradycardia - diagnosis; Bradycardia - physiopathology; Bradycardia - therapy; Complete AV block; Diagnosis, Differential; Dyspnea; Electrocardiography; Female; Females; Humans; Lyme carditis; Lyme disease; Lyme Disease - diagnosis; Lyme Disease - drug therapy; Lyme Disease - physiopathology; Pacemaker, Artificial; Syncope; Young Adult
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2018.12.005

Lyme disease is the most common tick-borne illness in North America. A 23-year-old female presented to our emergency department with a chief complaint of sudden dyspnea and chest pain. An electrocardiogram revealed a third degree heart block. She was a resident of the Northeast region of Mexico and referred a recent travel to an endemic area for Borrelia burgdorferi in the center of Mexico in the past weeks. Lyme carditis was diagnosed after enzyme linked immunosorbent assay for IgM antibodies against B. burgdorferi was reported positive and corroborated by a confirmatory immunoblot analysis. Persistent AV block was the only manifestation in our patient, a presentation scarcely reported in literature.