Three Cases of Lyme Carditis and a Review of Management

Abstract

Lyme carditis, primarily caused by Borrelia burgdorferi, affects 1 to 10% of patients with untreated Lyme disease. This study reviewed 3 cases of Lyme carditis that presented to a tertiary hospital's emergency department in the northeastern United States during the summer months. The cases involved patients with varying degrees of atrioventricular (AV) block: first-degree, second-degree Type 2, and complete heart block. Case 1 involved a 19-y-old male presenting with syncope and diagnosed with first-degree AV block. He received intravenous (IV) ceftriaxone, resulting in resolution of the AV block. Case 2 was a 22-y-old male who experienced an unresponsive episode with bystander chest compressions. He had discrete erythematous patches and was diagnosed with Type 2 second-degree AV block. IV ceftriaxone followed by doxycycline resolved his condition without further incident. Case 3 described a 32-y-old male with lightheadedness and syncope, diagnosed with complete heart block. A temporary pacing lead and IV ceftriaxone were employed, transitioning to doxycycline, which effectively resolved the heart block. All three patients tested positive for Lyme antibodies with reflex Western blot. Lyme carditis presents variably, often without a clear history of tick exposure or erythema migrans. Prompt recognition and treatment in endemic areas are critical to prevent implantation of unnecessary permanent pacemakers. This paper underscores the importance of high clinical suspicion and reviews appropriate management in the emergency department setting for patients with potential Lyme carditis presenting with unexplained cardiac symptoms.