 |  cardio Q
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| Author | 13 Posts |
nadiabarati
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A 35 year old man comes to the hospital after an episode of syncope. There were no preceding symptoms, and the patient recovered rapidly and completely with no residual effects. The patient did not have seizure activity during the episode. There is no history of heart disease and no previous episodes of syncope. The patient lives in rural Connecticut. His only previous medical problem was bilateral facial palsy several months ago. Currently, the physical exam is normal, except for a HR of 52/min. His blood pressure is normal. An EKG shows a sinus rhythm with Mobitz II second-degree heart block with a PR interval of 0.34 seconds. Echocardiogram is normal. He has a positive VDRL and negative FTA. What is the most appropriate management of this patient? A. Doxycycline in addition to electrophysiological studes.
B. Ceftriaxone in addition to pacemaker.
C. Ceftriaxone in addition to prednisone.
D. Ceftriaxone
E. Doxycycline in addition to permanent pacemaker.
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| saadtazjam
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E??
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| robin082006
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why not A?
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| study_ing
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bilateral facial paralysis--Lyme dz
pt has herat block as a result which is symptomatic, hence we probably req a pacemaker.
for late Lyme dz, i think ceftriaxone is used. if this pt has heart block and neuro symptoms, its probably late.
will have to confirm this one...
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| saadtazjam
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Is VDRL False positive in this case????or is a distractor??
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| study_ing
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false positive since FTA is negative
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| saadtazjam
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After rereading the question i am leaning towards A.Plz explain where i am going wrong in my thinking
Bilateral facial palsy several months ago:Not now
Syncope now HR bradycadia
EKG:Sinus rhythm(what does it say?)
Mobitz type I:Wenckeback:Where there is a progressive increase in PR interval untill one beat is dropped(In the question it just says PR increase
Mobitz type 2:PR interval is fixed but there are regualr non conducted Pwaves(no mention?)
VDRL +
Why cant we give some Doxo and investigate further?????????
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| Guptashutosh
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mobitz type 2 is cosidered dangerous type as has more chances to progress to type 3 heart block.... pacemaker is a must here... (i think )
i think studying is right
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| nadiabarati
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permanent pacemaker is not needed in type II second degree block.
one of the indications for permanent pacemaker is bifascicular block with intermittent type II second degree AV block. Do you know what it means? How do we recognize it in ECG?
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| saadtazjam
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What's yhe answer Nadia???
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| nadiabarati
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I don't know the answer yet!
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| anjushree
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ans----D
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| Guptashutosh
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an extract from emedicine.com :
Cardiovascular involvement:
Cardiovascular involvement occurs in fewer than 10% of patients with untreated Lyme disease and is more common in male patients than in female patients.
Palpitations, lightheadedness, and syncope may be a manifestation of varying degrees of heart block, including complete heart block, which occurs in 50% of patients with cardiac involvement. Lyme disease is an important reversible cause of heart block.
Chest pain and dyspnea can occur in the setting of Lyme pericarditis, myocarditis, and myopericarditis. Tamponade has been reported.
and the t/t :a high-degree heart block may be treated with intravenous ceftriaxone for 2-4 weeks. In the case of heart block, a permanent pacemaker rarely is necessary, but close monitoring in a telemetry unit is warranted. Once patients are no longer dependent on the pacemaker, their intravenous antibiotics may be switched to oral antibiotics. Occasionally, prednisone may hasten resolution of the conduction defect.
the link is http://www.emedicine.com/emerg/topic588.htm
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