Lyme Carditis Buried Beneath ST-Segment Elevations

Michalski, Bogdan; Reguero, Adrian Umpierrez De

doi:10.1155/2017/9157625

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…It may be expected that this would be more increased in myocarditis; however, human cases of Lyme carditis have also been reported where the troponin was within normal limits or only mildly elevated. [33][34][35] There were a number of limitations to our study, particularly pertaining to case 2, including the lack of urine protein quantification, lack of a post-mortem examination and lack of response to treatment, although the latter is common in dogs with Lyme carditis.…”

Section: Discussionmentioning

confidence: 99%

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First report of Lyme borreliosis leading to cardiac bradydysrhythmia in two cats

Tørnqvist‐Johnsen

Dickson

Rolph

et al. 2020

Journal of Feline Medicine and Surgery Open Reports

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Case series summary Two cats were presented for investigation of bradyarrhythmia detected by their referring veterinarians during routine examination. Both cats had extensive investigations, including haematology, serum biochemistry with electrolytes and thyroxine concentrations, systolic blood pressure measurement, echocardiography, electrocardiography and infectious disease testing. Infectious disease testing included serology for Toxoplasma gondii, Ehrlichia canis, Anaplasma phagocytophilum and Borrelia burgdorferi, and PCR for B burgdorferi antigen in both cats. Case 1 was also assessed by PCR for Bartonella henselae antigen and case 2 was assessed for Dirofilaria immitis by serology. All infectious disease tests, other than for B burgdorferi, were negative. Case 1 was diagnosed with Lyme carditis based on marked bradydysrhythmia, positive B burgdorferi serology, a structurally normal heart and clinical resolution with appropriate treatment with a 4-year follow-up. Case 2 was diagnosed with Lyme carditis based on marked bradydysrhythmia and positive B burgdorferi PCR; however, this cat had structural heart disease that did not resolve with treatment. Relevance and novel information This small case series describes two B burgdorferi positive cats presenting with newly diagnosed cardiac abnormalities consistent with those found in humans and dogs with Lyme carditis. Both cats were asymptomatic as perceived by their owners; the arrhythmia was detected by their veterinarians.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

First report of Lyme borreliosis leading to cardiac bradydysrhythmia in two cats

Tørnqvist‐Johnsen

Dickson

Rolph

et al. 2020

Journal of Feline Medicine and Surgery Open Reports

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“…Cardiac involvement has been reported with B.burgdorferi ss (US cases), B garinii, B afzelli [12] and B bissettii [10]. Patients with CHB (Complete heart block) due to LC may have erythema migrans [32, 36, 37, 47, 48, 58] or other manifestations such as joint involvement [8]. Basic investigations include the history of possible tick exposure, laboratory testing, a 12-channel electrocardiogram, 24-h Holter monitor, chest x-ray, and echocardiography [2].…”

Section: Discussionmentioning

confidence: 99%

First case report of inducible heart block in Lyme disease and an update of Lyme carditis

2019

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Background Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. Case presentation A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120–200 ms). Physical exam was unremarkable. The cardiologist’s initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. Conclusions Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.

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“…However, that particular case had a positive history for symptoms associated with the initial stages of Lyme disease, including erythema migrans weeks prior to evaluation, and lacked development of neurological complications [7]. …”

Section: Discussionmentioning

confidence: 99%

“…She did not have any evidence of cardiac dysrhythmias during her stay in the emergency room. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively [7,8]. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL.…”

Section: Casementioning

confidence: 99%

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction

Gilson

Khalighi

Elmi

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1 mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL. The patient underwent cardiac catheterization which did not show any significant obstructive coronary artery disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome. Abbreviations AV: Atrioventricular; CK-MB: Creatinine Kinase-MB; EKG: Electrocardiogram; ELISA: Enzyme-Linked Immunosorbent Assay; IgG: Immunoglobulin G; IgM: Immunoglobulin M

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Lyme Carditis Buried Beneath ST-Segment Elevations

Cited by 3 publications

References 6 publications

First report of Lyme borreliosis leading to cardiac bradydysrhythmia in two cats

First report of Lyme borreliosis leading to cardiac bradydysrhythmia in two cats

First case report of inducible heart block in Lyme disease and an update of Lyme carditis

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction

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