, Volume 4, Issue 5, pp 419-421
Date: 21 Jul 2009

Lyme carditis

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Dr. Russell Berger: Today’s case involves a 17-year-old girl presenting to the emergency department (ED) with syncope. The patient stated that she was in the supermarket when she felt dizzy, and fell to the ground. She struck her jaw on the floor. The patient reported that she had been dizzy for 2 days prior to passing out. She denied chest pain, shortness of breath, or palpitations. She also denied fevers, chills, arthralgias, or rashes.

Dr. Carlo Rosen: At presentation, did the patient have normal vital signs?

Dr. Berger: At the time of presentation, the patient had a highly concerning physical examination, and unstable vital signs. The patient had a temperature of 36.0, a heart rate of 30 beats per minute, a blood pressure of 88/42 torr, and a respiratory rate of 20 breaths per minute. She was saturating at 100% on 4 L of oxygen flow via nasal cannula. The pupils were dilated and minimally reactive. I did not appreciate any revealing odors on the patient’s breath. She had a 4 cm subme