Lyme carditis is self-limiting however, antibiotics can shorten the disease course. In the case of a complete heart block, atropine will be ineffective in increasing the heart rate, as it works on the AV node. Reversible causes of heart block should be treated. Medications such as isoproterenol and atropine can be considered to increase the SA nodal rate. Digitalis toxicity can be treated with a combination of digoxin immune Fab. Careful consideration should be taken in junctional arrhythmias as terminating it would also eliminate the sole source of conduction. If the AV dissociation is a consequence of supraventricular or ventricular tachycardias, termination of the arrhythmia is warranted. Treatment of the underlying cause often resolves the atrioventricular dissociation. Investigations into reversible causes of heart block are crucial for treatment as a pacemaker cannot be placed until such causes have been ruled out. Other causes may include hypothyroidism and viral myocarditis. Electrolytes should be drawn, and ECG should be observed for hyperkalemic changes, though the correlation between ECG changes and potassium levels is poor. Potassium levels of more than 7mmol/L can lead to AV conduction disturbances. These patients should be evaluated by a skin examination for an erythematous macular rash with central clearing, along with serological testing. 49% of patients with Lyme carditis are prone to develop third-degree heart block, especially those with a P-R interval of ≥300 ms. Lyme carditis, especially for patients in endemic areas. Further evaluation of reversible causes of heart block should be enacted. Moreover, the diagnosis of a complete heart block should not be made unless the ventricular rate is less than 40 beats per minute. Ventricular rate more than atrial rate: rules out complete heart block
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