Q; A 20-year-old male admitted in the month of August to ICU with chest pain, shortness of breath and palpitations. Patient's EKG in ED showed second-degree AV block. In ICU,  he is in intermittent AV block. The Patient recently started his college in the State of Maryland. What is your most probable diagnosis?


Answer: Lyme Carditis

Sudden cardiac death is the most dreaded complication in young healthy males. For reasons, not completely understood, it strikes young healthy males. Any young healthy male with unexplained AV blocks and travel or residence in states of Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota and New Hampshire, is suspected of Lyme carditis,  proved otherwise! It classically presents in the months of summer or early fall. Treatment is 2-3 weeks course of PO Amoxicillin or Doxycyclin. Severe disease requires IV infusion  of ceftriaxone or cefotaxime for 2-3 weeks.


Further Reading: 

Peter J. Krause, MD; Linda K. Bockenstedt, MD -

 Lyme Disease and the Heart 

Circulation, 2013; 127: e451-e454

Weblink: http://circ.ahajournals.org/content/127/7/e451.full