SHM Converge Scientific Abstract ePoster Gallery-Lyme Carditis With Early Warning Symptoms Preceding a Sinus Pause

Pdf Summary

This case highlights Lyme carditis as a potentially serious but reversible cause of conduction abnormalities. Lyme disease, caused by <em>Borrelia burgdorferi</em>, can progress from early symptoms to AV nodal blockade and even complete heart block if untreated.  

A 60-year-old man with a history of nonverbal seizure disorder presented after being found down and reported multiple syncopal episodes over the prior 24 hours. Before each episode, he experienced a “breeze-like sensation,” and afterward his heart rate dropped to the 20s. Initial ECG showed Mobitz type II heart block. EEG, electrolytes, lactate, and lamotrigine level were normal, making other causes less likely. He later had two witnessed sinus pauses lasting 8 seconds each.  

Because of suspected Lyme carditis, he was treated with 2 g of ceftriaxone. Lyme serologies returned positive, confirming the diagnosis.  

The case emphasizes that patients with Lyme carditis may have early warning symptoms such as presyncope or unusual sensations before episodes of bradycardia or syncope. When high-grade conduction disease is present, temporary pacing is preferred over permanent pacemaker placement because conduction often improves with antibiotic therapy. Intravenous ceftriaxone is recommended until clinical improvement, including resolution of high-grade block and PR interval shortening.  

Overall, prompt recognition and treatment of Lyme carditis are essential to prevent unnecessary permanent pacing and to allow recovery of cardiac conduction.

Asset Subtitle

Chris Musgrove

Meta Tag

Author List Chris Musgrove, Manasi Sejpal, Nicholas Maston, Salahuddin Nasir, Tanisha Kaur

Category Clinical Vignettes

Concept Lyme Disease

Concept Carditis

Concept Conduction abnormality

Concept Atrioventricular Block

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center

Presenting Author Chris Musgrove

Track Adult

Keywords

Lyme carditis

Borrelia burgdorferi

Mobitz type II heart block

AV nodal blockade

complete heart block

sinus pauses

syncope

ceftriaxone

temporary pacing

cardiac conduction recovery

Lyme Disease

Carditis

Conduction abnormality

Atrioventricular Block

Antibiotic Therapy