Lyme carditis: indications for cardiac pacing.

Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. It is the most common reported vector-borne illness in the United States. The clinical course of Lyme disease is divided into early and late phases. Early disease may be limited or disseminated. Generally, cardiac complications occur in the early disseminated phase. Disturbance of atrioventricular conduction is the most commonly recognized cardiac manifestation of Lyme disease. This is usually self-limited and does not require permanent cardiac pacing. A case of Lyme carditis with atrioventricular block requiring permanent pacing is reported and the indications for cardiac pacing in this disease are reviewed.

Cardiac manifestations of Lyme disease: a review.

OBJECTIVE: To describe the clinical features of cardiac manifestations of Lyme disease, the most common vector-borne illness in North America, which occasionally results in cardiac involvement. DATA SOURCES: A review of the English-language clinical literature pertaining to Lyme disease and Lyme carditis indexed in MEDLINE from 1975 to 1995. DATA EXTRACTION: Studies describing diagnosis, clinical features, treatment or outcome were reviewed. DATA SYNTHESIS: Cardiac complications of Lyme disease may occur in up to 8% of patients. Cardiac manifestations occur in the early phase of the illness, at a median of 21 days from the onset of erythema migrans. Manifestations of Lyme carditis include atrioventricular block, myopericarditis, intraventricular conduction disturbances, bundle branch block and congestive heart failure. Temporary cardiac pacing may be required in up to a third of cases and complete recovery occurs in most (greater than 90%) patients. The overall prognosis of Lyme carditis is very good, although recovery may be delayed and late complications such as dilated cardiomyopathy may occur. CONCLUSION: Lyme disease is a tick-borne spirochetal infection caused by Borrelia burgdorferi. Cardiac complications of Lyme disease generally occur in the early phase and include conduction system disturbances, myopericarditis and congestive heart failure.

Spongy left ventricular myocardium in an adult.

"Spongy left ventricular myocardium," or noncompaction of left ventricular myocardium, is a rare disorder of endomyocardial morphogenesis. It is usually seen in the pediatric population and is often associated with other congenital cardiac malformations. We describe an adult with noncompaction of left ventricular myocardium without associated congenital cardiac anomalies.