try this 2 - usmlegold

[ArchivalUser]

A 30-year-old man comes to the clinic for evaluation of joint pain. For the last month, he has
suffered from diffuse arthralgias and myalgias, as well as low-grade fever, occasional
palpitations, and fatigue. He is normally quite active and loves nature. He reports spending
upward of 2 weeks at a time hiking throughout the Northeastern United States and Western
Europe. The man cannot recall any rash but does report that he occasionally suffers tick bites.
These have never bothered him; he simply pulls them off his leg and throws them in the fire.
Past medical history is significant for a 3-week bout of facial nerve paralysis. Vital signs are:
temperature 37.0 C (98.6 F), blood pressure 122/70 mm Hg, pulse 55/min, and respirations
20/min. Physical examination, aside from some ectopy on cardiac auscultation, is
unremarkable. Which of the following is the most likely cardiac abnormality?
A. Dilated aortic root on transthoracic echocardiogram
B. Dilated cardiomyopathy on transthoracic echocardiogram
C. Electrocardiogram showing atrioventricular block
D. Electrocardiogram with diffuse ST-segment elevations
E. Electrocardiogram with low-amplitude QRS complexes

[ArchivalUser]

no sure maybe lyme but no rash, just give a try

C. Electrocardiogram showing atrioventricular block???

[ArchivalUser]

C.

[ArchivalUser]

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. Lyme disease is associated with a host of cardiac, neurologic,
and rheumatologic complaints. Among cardiac complications of Lyme disease, the
classic presentation is palpitations with varying degrees of atrioventricular block (choice
C). Without treatment, the degree of block may be progressive, causing syncope from an
inadequate ventricular escape rhythm. In addition to heart block, there are usually
nonspecific ST- and T-wave changes due to myocarditis from direct infection with B.
burgdorferi.
A dilated aortic root on transthoracic echocardiogram (choice A) would be an expected
finding if this patient had cardiac manifestations of syphilis. Infection with the spirochete
Treponema pallidum can cause a proximal thoracic aortic aneurysm and eventual
valvular dysfunction.
Dilated cardiomyopathy (choice B) is rarely associated with Lyme disease. The most
common abnormalities are atrioventricular block and a mild myocarditis. Left ventricular
failure occurs in less than 5% of infected patients with cardiac complaints. Twenty
percent have conduction abnormalities, whereas 70% of patients will complain of
intermittent palpitations.
Pericarditis, manifesting on electrocardiogram as diffuse ST-segment elevations (choice
D), is a rare manifestation of Lyme disease. Myocarditis, which occurs in 10% of patients
and presents with nonspecific ST- and T-wave abnormalities, is much more common
than frank pericarditis.
Low-amplitude QRS complexes (choice E) are seen with pericardial effusions.