Background Patient is a young female with no medical history. Case A 33 y.o Hispanic female visiting from out of town presented to our Chicagoland area emergency room for 2 weeks of palpitations, intermittent chest pain, dyspnea on exertion, and malaise with two associated syncopal episodes. Initial electrocardiogram (ECG) demonstrated an accelerated junctional tachycardia and initial lab parameters revealed a hs-cTnl of 38 ng/L. Patient was then started on diltiazem which was stopped within 24 hours due to development of intermittent 3rd degree atrioventricular (AV) block and QTc prolongation on overnight telemetry. The following day, exercise stress testing exhibited prolonged 1st degree AV block with intermittent progression to symptomatic 2nd degree AV block with 2:1 conduction. HIV, TSH, Syphilis, ANA, peripheral blood smear, TTE, and cardiac MRI were unremarkable. CBC and iron studies reflected mild anemia. Following 72 hours, Lyme disease (LD) serology resulted positive. Patient was started on IV ceftriaxone. By the 4th day, symptoms resolved and the ECG showed improvement in the PR interval from 408 ms to 286 ms. The patient was discharged on PO doxycycline. Decision-making LD is a multi-system inflammatory disease caused by Borrelia burgdorferi which is endemic to the Northeastern United States. Despite classic medical school teachings, erythema migrans is only present in 40-80% of cases. While atrioventricular is the most common cardiac finding, junctional and fascicular arrythmias have been reported. Moreover, Hispanic and Black patients more often present with disseminated disease, potentially due to a failure to recognize dermatologic findings in those with a darker complexion, and reduced access to medical care. This case spotlights the delayed diagnosis of a Hispanic female with Lyme Carditis in a nonendemic area. Because the number of spirochetes in cardiac tissue is correlated to the degree of conduction abnormalities, swift diagnosis is crucial in preventing sudden cardiac death and unnecessary medical testing. Conclusion Providers should be aware of the racial disparities in LD and maintain high clinical suspicion for patients residing in or coming from endemic areas. https://www.jacc.org/doi/full/10.1016/S0735-1097(23)03253-9
