Fatal Lyme carditis presenting as fluctuating high-grade atrioventricular block

(A) Risk areas for Lyme disease as determined by the presence of ticks capable of Borrelia burgdorferi transmission (cross-hatched areas). Based on surveillance data collected by the Public Health Agency of Canada (2009–2016). © All rights reserved. Risk of Lyme disease to Canadians. Public Health Agency of Canada, 2018. Adapted and reproduced with permission from the Minister of Health, 2019. “Lyme disease risk areas map” is available at www.canada.ca/en/public-health/services/diseases/lyme-disease/risk-lyme-disease.html#map. (B) Reported cases of Lyme disease in the United States, 2018. Map from the Centers for Disease Control and Prevention (CDC). Each dot represents 1 case of Lyme disease and is placed randomly in the patient’s county of residence. The presence of a dot in a state does not necessarily mean that Lyme disease was acquired in that state. Grey shading indicates states with high incidence. CDC materials used are in the public domain. “Reported cases of Lyme disease — United States, 2018” is available at www.cdc.gov/lyme/datasurveillance/maps-recent.html.