PMC10205533_01
Initial ECG showing normal sinus rhythm with complete heart block with a narrow QRS complex (top) and a rhythm strip showing complete heart block with many non-conducted P-waves and prolonged ventricular pauses.
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An initial electrocardiogram (ECG) revealed complete heart block with a heart rate of 55 bpm (Fig. 1), so a temporary pacemaker was urgently inserted.
Echocardiography from apical 4-chamber views showing tricuspid regurgitation (left) and mitral regurgitation (right) during diastole. Red marker on the ECG denotes where in the cardiac cycle the image was taken.
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An echocardiogram showed diastolic tricuspid and mitral regurgitation (Fig. 2).
Follow up ECG showing normal sinus rhythm with first degree AV block and a PR interval of 280 ms.
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Follow up ECG on day 10 showed first degree atrioventricular (AV) node block with a PR interval of 280 ms and a heart rate of 64 bpm (Fig. 3).
Bar graph showing the increasing incidence of Lyme disease in the United States between the years 1996 and 2019 and the seasonal patterns of Lyme disease infection in the U.S. by week of onset, between the years 2008 and 2019, using CDC data. The patient's tick bite likely occurred between weeks 14-22 (April-May) and Lyme disease presentation occurred between weeks 27-30 (July).
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The patient was then transitioned to oral doxycycline 100 mg PO BID to complete total 4-week course of antimicrobials and was discharged Fig. 4.