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Rare disease
CASE REPORT
Lyme carditis presenting as atrial fibrillation
  1. Abir Zainal1,
  2. Amir Hanafi1,
  3. Ninad Nadkarni1,
  4. Mahmood Mubasher1,
  5. Deeraj Lingutla1 and
  6. Ryan Hoefen2
  1. 1 Department of Internal Medicine, Unity Hospital, Rochester, New York, USA
  2. 2 Department of Cardiology, Rochester Regional Health, Rochester, New York, USA
  1. Correspondence to Dr Abir Zainal, abir.zainal{at}rochesterregional.org

Abstract

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.

  • arrhythmias
  • pacing and electrophysiology
  • cardiovascular system
  • infections

https://doi.org/10.1136/bcr-2018-228975

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    Footnotes

    • Contributors AZ: was the primary author for writing the case and discussion. AH, NN and MM: contributed to writing the case. DL and RH: edited the case report and were the senior physicians primarily responsible for the patient’s care.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.