Abstract 11592: The Great Imitator: A Case of Lyme Carditis Mimicking ST Elevation Myocardial Infarction

Abstract

Background: In the US, approximately 476,000 patients are diagnosed with Lyme disease annually. 1 to 5 % of patients with Lyme disease have cardiac involvement, predominantly conduction system abnormalities, less frequently endocarditis, valvular heart disease, and myopericarditis. We present a case of acute Lyme carditis mimicking ST-segment elevation myocardial infarction (STEMI). Case Presentation: A 31-year-old female with no past medical history presented to the hospital with chest pain, fatigue and chills for one day. She had a blood pressure of 101/61 mmHg, a heart rate of 88/minute, was afebrile, and saturating 99% on room air. Labs revealed elevated troponin of 8712 pg/ml and elevated C-reactive protein of 30 mg/l. EKG showed sinus rhythm with HR of 84, normal axis with ST elevation in leads II, III, AVF, and reciprocal ST segment depression in leads I and AVL. Decision Making: STEMI code was activated, patient's cardiac catheterization did not show any occlusion or left ventricle apical ballooning. Transthoracic echocardiogram was normal with left ventricular ejection fraction of 55 to 60% without wall motion abnormalities. Myopericarditis workup revealed ELISA Lyme Immunoglobulin (Ig)M antibodies with a negative IgG antibodies. Western blot test was positive for IgM, suggesting acute Lyme carditis. Patient's chest pain resolved with Celecoxib and Colchicine and treated with intravenous antibiotics. Conclusion: Lyme carditis mimicking acute coronary syndrome is rarely described in the literature. Lyme carditis should be considered in differential diagnoses in patients presenting with signs of myocardial ischemia with normal cardiac catheterization.