Abstract 15279: Dizziness, Clots, and Heart Failure: Reasons to Stay Out of the Lymelight

Case: A 46-year-old man with history of hypertension and hyperlipidemia presented with one month of fatigue and lightheadedness. He lived in California but had recently visited Ireland. His examination was significant for bradycardia. An electrocardiogram revealed complete heart block with a junctional escape rhythm at 40 beats per minute. Laboratory testing was remarkable for a troponin of 1.8 ng/ml. An echocardiogram was unremarkable and coronary angiography revealed no significant disease. Cardiac magnetic resonance imaging demonstrated no abnormal delayed enhancement and two clots in the right ventricular apex. (Fig 1). With no obvious reversible cause identified, patient underwent dual-chamber pacemaker implantation. Testing for Lyme disease eventually returned with a positive enzyme immunoassay, and an antibody level of 1.16. Immunoblots for both IgM and IgG were interpreted as negative but demonstrated reactive 41 kD and 66 kD IgG bands. The patient was started on an empiric doxycycline and subsequ...