We discussed a case of a previously healthy young man who presented with recent travel history to the NE United States, subacute-chronic myalgias & headaches, acute left Bell’s palsy, and acute palpitations, found to have sinus and AV nodal disease due to Lyme disease

Lyme carditis

• Presented <1-28 weeks after infection onset
• AV conduction block of varying severity is usually more common than sinus node & distal conduction system disease
• ↑ risk of complete AV block if PR > 300 ms
• Treatment:
  • If PR > 300 ms:  IV penicillin or IV ceftriaxone x28 days
  • If PR < 300 ms:  PO antibiotics (e.g. doxycycline x14-28 days)