Lyme Carditis: More Than Atrioventricular Block
When managing a patient with unexplained post-syncope hypotension and evidence of myocardial stunning or akinesis on ultrasound, especially in an endemic area, consider Lyme carditis. While AV block is classic, remember that myocarditis can present with profound hemodynamic compromise requiring aggressive resuscitation while maintaining a high index of suspicion for infectious triggers.
This case report details a concerning presentation in an older male who experienced syncope and pulseless arrest, requiring defibrillation before arriving at the emergency department. Upon arrival, the patient was hypotensive and exhibited apical akinesis on point-of-care ultrasound about 30 minutes after regaining spontaneous circulation. Given the context of potential Lyme exposure in Northern New England, the authors raised suspicion for a diagnosis of Lyme carditis, suggesting that cardiac manifestations can extend beyond simple atrioventricular block. This highlights that acute hemodynamic instability and myocardial dysfunction following syncope need to prompt consideration of infectious etiologies like Lyme disease, even when initial workup might point elsewhere.