Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of Lyme carditis, including palpitations, syncope, near-syncope, or dyspnea. History of recent tick exposure or erythema migrans rash noted. Review of systems positive for constitutional symptoms (fever, fatigue, myalgias). No prior history of structural heart disease or conduction abnormalities.
Clinical Examination Findings
Cardiovascular exam reveals irregular rhythm or bradycardia. Auscultation may demonstrate S1/S2 variations or new murmurs. Vital signs indicate potential heart block (e.g., PR interval prolongation on ECG). Skin exam: Search for erythema migrans or other dermatologic manifestations of Borrelia burgdorferi. Neurological exam: Assess for cranial nerve palsies or radiculopathy.
Treatment Protocol
Initiate intravenous ceftriaxone 2g daily for high-grade AV block or symptomatic patients. Transition to oral doxycycline (100mg BID) or amoxicillin (500mg TID) once conduction stabilizes. Continuous cardiac telemetry monitoring required until AV conduction improves. Cardiology consultation for potential temporary pacemaker placement if hemodynamically unstable.