Introduction. Lyme disease is an infectious disease transmitted by the Ixodes ticks and is manifested by damaging various organs and systems (most often-migrating erythema, damage to the nervous system, musculoskeletal system, heart, liver and eyes). According to various authors, heart damage in Lyme borreliosis ranges from 4% to 10% and is an understudied pathology. Case report. The article describes a clinical case of infectious myocarditis associated with Lyme disease in a 51-year-old patient. The course of the disease and the results of treatment of the patient were analyzed. The severe rhythm and conduction disorders were revealed: antrioventricular (AV) block of the first degree, transient AV block of the II degree (Mobitz 2) and III degree, polytopic extrasystoles. Due to timely diagnosis, including serological, prescribed etiotropic antibacterial treatment, the patient achieved a significant improvement in both clinical condition and positive serological and electrocardiogram (ECG) dynamics with improved AV conduction. Conclusions. The most frequent ECG changes in Lyme carditis (LC) are conduction disorders with the development of blockades of various stages. For patients with myocarditis, which is accompanied by complex arrhythmias, and conduction disorders estimated as intermediate and high risk by Suspicious Index in Lyme Carditis (SILC) scale, serological examination should be recommended in order to verify the borreliosis etiology of myocarditis. In this particular case, early diagnostics and prescribed etiotropic treatment, in addition to treatment of heart failure, contributed to a significant improvement in both the clinical condition and positive serological and ECG dynamics.
References
1.
Shkilna M, Andreychyn M, Korda M, Pokryshko O, Humenna R, Huk M, et al. Serological Surveillance of Hospitalized Patients for Lyme Borreliosis in Ukraine. Vector-Borne and Zoonotic Diseases. 2021;21(4):301–3.
2.
Afari ME, Marmoush F, Rehman MU, Gorsi U, Yammine JF. Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back. Case Reports in Cardiology. 2016;2016:1–3.
3.
Timmer SAJ, Boswijk DJ, Kimman GP, Germans T. A case of reversible third-degree AV block due to Lyme carditis. Journal of Electrocardiology. 2016;49(4):519–21.
4.
Besant G, Wan D, Yeung C, Blakely C, Branscombe P, Suarez‐Fuster L, et al. Suspicious index in Lyme carditis: Systematic review and proposed new risk score. Clinical Cardiology. 2018;41(12):1611–6.
5.
Shenthar J, Shetty SB, Krishnamurthy D. Diagnosis not to be missed: Lyme carditis, rare but reversible cause of complete atrioventricular block. Indian Heart Journal. 2014;66(6):723–6.
6.
Scheffold N, Herkommer B, Kandolf R, May AE. Lyme Carditis. Deutsches Ärzteblatt international.
7.
Kostić T, Momčilović S, Perišić ZD, Apostolović SR, Cvetković J, Jovanović A, et al. Manifestations of Lyme carditis. International Journal of Cardiology. 2017;232:24–32.
8.
Fuster LS, Gul EE, Baranchuk A. Electrocardiographic progression of acute Lyme disease. The American Journal of Emergency Medicine. 2017;35(7):1040.e5-1040.e6.
9.
Zinchuk O. Syntropic Heart Disorders in Patients with Lyme Borreliosis (Clinical and Electrocardiographic Characteristics, Presentation of Case Report). Lviv clinical bulletin. 2013;2(2):48–51.
10.
Andreichyn MA, Shkilna MI, MM K. Two-stage diagnosis of Lyme borreliosis in forestry workers. Journal Of The National Academy Of Medical Sciences Of Ukraine. 2019;25:71–6.
11.
Manek M, Kulkarni A, Viera A. Hint of Lyme, an uncommon cause of syncope. BMJ Case Reports. 2014:bcr2013201547.
12.
Krause PJ, Bockenstedt LK. Lyme Disease and the Heart. Circulation. 2013;127(7).
13.
Ammirati E, Veronese G, Bottiroli M, Wang DW, Cipriani M, Garascia A, et al. Update on acute myocarditis. Trends in Cardiovascular Medicine. 2021;31(6):370–9.
14.
Myndziv KV, Yarema NI, Vereshchahina NYa, Bondarchuk VI, Hevko UP, Vayda OV. Application of diagnostic methods in the verification of Lyme carditis (clinical case). Medicni perspektivi. 28(3):205–12.
15.
Yeung C, Baranchuk A. Diagnosis and Treatment of Lyme Carditis. Journal of the American College of Cardiology. 2019;73(6):717–26.
16.
About the statement of The list of especially dangerous, infectious and parasitic diseases to the person and carriers of activators of these diseases. Order of Ministry of Health of Ukraine dated 19071995. (133).
17.
Malyi VP, Shepylieva NV. Lyme disease: an algorithm for predicting the effectiveness of etiotropic therapy. J of V N Karazin KNU. 2012;998:57–64.
18.
Błaut-Jurkowska J, Olszowska M, Kaźnica-Wiatr M, Podolec P. Borelioza serca [Lyme carditis. Pol Merkur Lekarski. 2015;39(230):111–5.
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