Bradycardia Bites in New England
55 y/o F presents with acute onset lightheadness usually worse when lying down at night and dyspnea on exertion for the last three days with a recent history of outdoor activity near the Cape and ticks on her cat! (less than 4 weeks ago)
Pt admitted with HR of 36, BP 134 59 and afebrile. No rash, joint or neurologic symptoms on exam. Initially pt was on PO Doxy and then when her titers came back negative, abx were discontinued and she was sent home with a permanant pacer.
Is her clincal gestault suggestive of Lyme ? (the CDC reccomends abx with no serologic testing if you think > 80%)
What is your antibiotic of choice? (for Lyme Carditis use IV 3rd gen cephalosporin)
The differential for AV block? Clinical Importance of differentiating intra and infranodal disease in 2:1 AV Block. Indications for permanent pacing?
Diagnosis and Treatment of Lyme Disease *Bratton