Figure 1 demonstrates what appears to be sinus tachycardia with left bundle-branch block. Closer evaluation of the rhythm strip reveals a P wave that is partially obscured by the T wave consistent with 2:1 atrioventricular (AV) conduction suggestive of infranodal disease (red arrows in Figure 2).
On further questioning, the patient reported owning a farm in southern Minnesota. He reported noting occasional ticks on his body but no known tick bites. Two weeks prior to his presentation he had a self-limited 4-day febrile illness with rigors.
Infecting the Electrocardiogram—Discussion. Arch Intern Med. 2012;172(21):1623–1625. doi:10.1001/archinte.172.21.1623
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