Complete Heart Block Due to Lyme Carditis in Two Pediatric Patients and a Review of the Literature

Silver, Eric S.; Pass, Robert H.; Kaufman, S; Hordof, Alan J.; Liberman, Leonardo

doi:10.1111/j.1747-0803.2007.00122.x

Cited by 24 publications

(15 citation statements)

References 26 publications

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“…6,7 This knowledge is useful when counseling patients about the expected time course for improvement and reinforces the adult experience that permanent pacemaker implantation is rarely required. 4,19,28 Isolated case reports suggest that disturbances in atrioventricular conduction can rarely be permanent after Lyme carditis, as we saw with 1 patient who had persistent second-degree AVB.…”

Section: Figurementioning

confidence: 83%

“…2,19,26,27 Although corticosteroids are sometimes advocated, there is no evidence that they are beneficial in patients with Lyme carditis and advanced heart block. 3,7,22,28 No patient in this series received corticosteroids.…”

Section: Figurementioning

confidence: 91%

“…3,4 Studies regarding Lyme carditis in children are limited to reports of 1 to 3 cases (Table 1). [5][6][7][8][9][10][11][12][13] The incidence of advanced heart block and time required for recovery of atrioventricular conduction have not been well characterized.…”

mentioning

confidence: 99%

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Lyme Carditis in Children: Presentation, Predictive Factors, and Clinical Course

Costello¹,

Alexander²,

Greco³

et al. 2009

Pediatrics

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The spectrum of presentation for children with Lyme carditis is broad, ranging from asymptomatic, first-degree heart block to fulminant myocarditis. Variable degrees of heart block are the most common manifestation and occasionally require temporary pacing. Transient myocardial dysfunction, although less common, can be life-threatening. Advanced heart block resolves within 1 week in most cases. In children with early disseminated Lyme disease, older age, arthralgias, and cardiopulmonary symptoms independently predict the presence of carditis.

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Section: Figurementioning

confidence: 83%

Section: Figurementioning

confidence: 91%

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Lyme Carditis in Children: Presentation, Predictive Factors, and Clinical Course

Costello¹,

Alexander²,

Greco³

et al. 2009

Pediatrics

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“…Lyme carditis is the commonest cause of acquired complete AV heart block in pediatric patients in the United States and occurs in 2% to 10% of patients with Lyme disease. 8,9 In the systematic review of the literature of Batra et al, 10 they identified a total of 40 children with acute myocarditis complicated by an advanced AV block; an etiology of myocarditis was identified in only 12 (30%) of the 40 children, with the most common pathogens being coxsackie B virus (n = 4), respiratory syncytial virus (n = 2), and Mycoplasma pneumoniae (n = 2). Other rare causes of acquired complete AV block in children include acute rheumatic fever, 11 intracardiac yolk sac tumor, 12 endomyocardial fibrosis, 13 Teebi hypertelorism (hypertelorism, with a facial appearance that can resemble craniofrontonasal dysplasia, limb anomalies, urogenital defects), 14 Lafora disease, 15 familial dysautonomia, 16 and sevoflurane anesthesia.…”

Section: History and Physical Examinationmentioning

confidence: 98%

Asymptomatic Complete Atrioventricular Block in a 13-Year-Old Girl

Sykes

Lubega²,

Ezetendu³

et al. 2011

Pediatric Emergency Care

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Atrioventricular (AV) block is a delay or an interruption in the transmission of an impulse from atria to ventricles due to an anatomic or a functional impairment in the conduction system. Atrioventricular block may be congenital or acquired. Electrocardiographic screening of asymptomatic school-aged children (median, 12.4 years) in Japan found the prevalence of a third-degree AV block to be 2 per 100,000. We report a case of asymptomatic complete AV block of unknown etiology in a 13-year-old child who did not require pacemaker placement. The importance of recognizing an asymptomatic complete AV block in the pediatric population, the classification and controversies of pacemaker placement, and the complications of pacemaker placement are discussed.

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“…Silver and his colleagues found only 34 cases in the English literature describing documented cases of Lyme carditis in patients aged 23-47 years of age. They report on two male patients aged 15 and 17 who developed complete heart block [12].…”

Section: Dr Wolfe: How Common Is This Entity?mentioning

confidence: 99%

Lyme carditis

Berger

McGillicuddy

2009

Intern Emerg Med

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Dr. Russell Berger: Today's case involves a 17-year-old girl presenting to the emergency department (ED) with syncope. The patient stated that she was in the supermarket when she felt dizzy, and fell to the ground. She struck her jaw on the floor. The patient reported that she had been dizzy for 2 days prior to passing out. She denied chest pain, shortness of breath, or palpitations. She also denied fevers, chills, arthralgias, or rashes.Dr. Carlo Rosen: At presentation, did the patient have normal vital signs?Dr. Berger: At the time of presentation, the patient had a highly concerning physical examination, and unstable vital signs. The patient had a temperature of 36.0, a heart rate of 30 beats per minute, a blood pressure of 88/42 torr, and a respiratory rate of 20 breaths per minute. She was saturating at 100% on 4 L of oxygen flow via nasal cannula. The pupils were dilated and minimally reactive. I did not appreciate any revealing odors on the patient's breath. She had a 4 cm submental laceration. The cardiac examination revealed an irregular heartbeat, without murmurs, rubs, or gallops. No adventitial lungs sounds were present. The patient's abdomen was distended, and diffusely tender to palpation. The bowel sounds were hypoactive and the stool was hemoccult negative. The patient's skin was dry, and did not demonstrate any rashes. Linear scars were seen on the patient's left forearm. The patient's affect was blunted, and the patient was combative during the examination (Fig. 1).Dr. Jonathan Edlow: Were you concerned for a toxic ingestion?Dr. Berger: We learned from paramedics that the patient had attempted to kill herself twice before. The history was significant for guaifenesin overdose a month prior as well as an overdose on aspirin and muscle relaxants a year prior. Given the affect, the scarring on the arm, and the history of suicide attempts, toxic ingestion was at the top of our differential.Dr. Shamai Grossman: How did your workup proceed?Dr. Berger: Given the patient's hypotension and bradycardia, our first goal was, of course, to ensure hemodynamic stability. Pacer pads were placed on the patient, and an EKG was performed. The EKG was notable for a third degree heart block. Within minutes of arrival, the patient's mental status worsened. We elected to intubate her for airway protection as we continued to work her up. Once intubated, we transcutaneously paced the patient, and placed a right sided internal jugular line to enable transvenous pacing. A complete set of laboratory tests were obtained including a complete blood count, serum chemistry, liver function tests, lactate, toxicology screen, urinalysis, urine pregnancy test, and Lyme disease titers.Dr. Steven Traub: What results were you able to obtain right away?Dr. Berger: The patient's complete blood count revealed a white count of 16,000 cells/mm 3 and an elevated lactate. The serum chemistry demonstrated eukalemia and euglycemia. The urine pregnancy test was negative. The urine and serum toxicology screens were not immediately known to us.

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Complete Heart Block Due to Lyme Carditis in Two Pediatric Patients and a Review of the Literature

Cited by 24 publications

References 26 publications

Lyme Carditis in Children: Presentation, Predictive Factors, and Clinical Course

Lyme Carditis in Children: Presentation, Predictive Factors, and Clinical Course

Asymptomatic Complete Atrioventricular Block in a 13-Year-Old Girl

Lyme carditis

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