{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:12:36Z","timestamp":1772136756151,"version":"3.50.1"},"reference-count":14,"publisher":"ALUNA","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,15]]},"abstract":"<jats:p>This case report explores the spectrum and mechanisms of myocardial involvement in Lyme carditis, integrating clinical and imaging findings to better understand the disease course and its management implications. While conduction abnormalities are the most well-recognized cardiac manifestation of Lyme carditis, our findings highlight the importance of myocardial work assessment by echocardiography in the early stage of the disease and by cardiac magnetic resonance in the late stage. These insights may guide clinicians in early recognition, targeted therapy, and prevention of adverse cardiac outcomes in Lyme carditis and other forms of myocarditis. We report the case of a 44-year-old male presenting with complete atrioventricular block. Myocardial work assessment by echocardiography was performed to investigate the underlying etiology, revealing findings suggestive of an inflammatory myopericardial syndrome as the cause of the conduction abnormality. The Suspicious Index in Lyme Carditis suspicious (SILC) score indicated an intermediate probability of Lyme infection, which was subsequently confirmed by laboratory testing. The patient was treated with intravenous ceftriaxone, resulting in resolution of the conduction disturbance and obviating the need for pacemaker implantation. During follow-up, myocardial work parameters were reassessed, and cardiac magnetic resonance imaging was performed, both supporting remission with residual changes and providing additional prognostic insights.<\/jats:p>","DOI":"10.36740\/merkur202601113","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T19:43:05Z","timestamp":1772134985000},"page":"84","source":"Crossref","is-referenced-by-count":0,"title":["Myocardial work indices and cardiac magnetic resonance in the diagnosis and follow-up of Lyme carditis presenting with intermittent complete heart block"],"prefix":"10.36740","volume":"54","author":[{"given":"Ma\u0142gorzata","family":"Ma\u0142ek-Elikowska","sequence":"first","affiliation":[{"name":"2nd DEPARTMENT OF CARDIOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldemar","family":"Elikowski","sequence":"additional","affiliation":[{"name":"DEPARTMENT OF INTERNAL MEDICINE, JOSEF STRUS HOSPITAL, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julita","family":"Fedorowicz","sequence":"additional","affiliation":[{"name":"2nd DEPARTMENT OF CARDIOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyntia","family":"Szyma\u0144ska-\u0141yczkowska","sequence":"additional","affiliation":[{"name":"2nd DEPARTMENT OF CARDIOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justyna","family":"Rajewska-Tabor","sequence":"additional","affiliation":[{"name":"1st DEPARTMENT OF CARDIOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Klusek-Zieli\u0144ska","sequence":"additional","affiliation":[{"name":"DEPARTMENT OF RADIOLOGY, HCP MEDICAL CENTER, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artur","family":"Baszko","sequence":"additional","affiliation":[{"name":"2nd DEPARTMENT OF CARDIOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22436","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1. Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis, and treatment of Lyme disease. Arthritis Rheumatol. 2021;73(1):12-20. doi:10.1002\/art.41562.","DOI":"10.1002\/art.41562"},{"key":"ref1","unstructured":"2. Elikowski W, Ma\u0142ek M, Flieger J, Baszko A, Fagiewicz A, Wroblewski D. Complete heart block and Lyme disease: report of two different cases and literature review. Kardiol Pol. 2007;65(5):565-70. doi:10.33963\/v.kp.80913 (Polish)."},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3. Mangaroo R, Marchetta S, Dulgheru R, Ilardi F, Sugimoto T, Robinet S, et al. Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study. 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Unclassified cardiomyopathy or Lyme carditis? A three-year follow-up. Kardiol Pol. 2013;71(3):283-5. doi:10.5603\/KP.2013.0043 (Polish).","DOI":"10.5603\/KP.2013.0043"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"14. Aquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, et al.; Cardiac Magnetic Resonance Working Group of the Italian Society of Cardiology. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function: ITAMY study. 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