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(Circulation. 2008;118:1881-1884.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Lyme Carditis

Mohit Naik, MD; Danny Kim, MD; Francis O'Brien, MD; Leon Axel, MD, PhD; Monvadi B. Srichai, MD

From the Department of Radiology, Cardiac Imaging Section (M.N., D.K., L.A., M.B.S.), and Department of Medicine, Cardiology Division (F.O., L.A., M.B.S.), New York University School of Medicine, New York, NY.

Correspondence to Monvadi B. Srichai, MD, FACC, Department of Radiology and Medicine, New York University School of Medicine, 530 First Ave, HCC-C48, New York, NY 10016. E-mail srichm01@med.nyu.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 59-year-old man with a history of hypertension and hyperlipidemia was admitted to the hospital for evaluation of extreme fatigue and recurrent syncope. He had a history of syncope 2.5 years before the current admission and again 7 weeks before. The patient was taking atenolol, atorvastatin, and low-dose aspirin at the time of his symptoms. Diagnostic evaluation before admission included normal physical examination findings: He was afebrile with normal blood pressure and heart rate. The patient underwent echocardiography, which demonstrated mild left ventricular hypertrophy and normal cardiac function (online-only Data Supplement Movie I). He was referred for exercise stress testing but was found to be in atrial fibrillation with a slow ventricular response. He spontaneously converted to normal sinus rhythm with first degree-atrioventricular (AV) heart block (PR interval 0.52 seconds) with periods of second-degree AV heart block (Figure 1A). Given the new heart block, atenolol was stopped and the patient was admitted for cardiac monitoring and further diagnostic evaluation.

View larger version (27K):   Figure 1. Twelve-lead ECG. A, Initial ECG demonstrates second-degree heart block. B, Six-week follow-up ECG demonstrates first-degree heart block.

Initial physical examination on admission was significant for low-grade fever to 100.9°F, blood pressure 140/80 mm Hg, and heart rate 44 bpm and irregular. Remainder of examination was normal including the cardiac examination. Chest x-ray was normal (Figure 2). Laboratory data revealed normal cardiac enzymes and electrolytes and negative blood cultures. Patient denied recent tick bite or exposure and did not present with a rash, but given fever . . . [Full Text of this Article]