Clinical case of borreliosis myocarditis

Abstract

Annotation. The purpose of the work is to demonstrate the peculiarities of its course, modern methods of diagnosis and treatment on the example of a clinical case of borreliosis myocarditis. According to the results of the patient's ECG, a transient atrio-ventricular block of the first degree was established. The results of general clinical methods of examination of the patient generally corresponded to the reference values. According to the results of Holter ECG monitoring, a diagnosis of mild myocarditis, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle was made. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block. Because specific cardiovascular lesions occurred for no apparent reason and symptoms occurred during peak tick activity, the patient was re-interviewed for migratory erythema and tick bites. The patient confirmed being in the forest during the disease season and sucking the mite without specific skin lesions. To further search for the etiological factor that led to the identified changes, the patient was tested for antibodies to Burrelia burgdorferi by ELISA. The obtained positive result (Ig G – 3.89 IU/ml, Ig M – 33.74 IU/ml) indicated an acute period of Lyme disease. Thus, the final diagnosis was: Lyme disease, stage II (early disseminal). Subacute infectious (borreliosis) myocarditis, mild course, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block of the I degree. Treatment is prescribed: doxycycline 100 mg x 2 times/day, metoprolol 25 mg x 2 times/day, metabolic therapy and serological tests are recommended after 3, 6, 12 months and 2 years. Thus, the clinical case shows the difficulties of diagnosing “borreliosis myocarditis”, emphasizes the prospects for the development of algorithms for the diagnosis and treatment of borreliosis myocarditis.