Clinical question of the week: what's the diagnosis here?

46 year-old male with no significant past medical history and excellent exercise tolerance (2-3 miles jogging/day) symptoms of palpitations, some mild chest pain, and evolution of a rash 4-6 weeks prior of note pt frequently visits SE Massachussetts, had a significant other living in that area, and area is known to have a high incidence of 'tick infestations’. EKG in ER showed:   Skin exam showed: 1. What is the most likely diagnosis? 2. Would you treat empirically? What would you start? 3. Is it appropriate to try atropine or isoproterenol? 4. Is a pacemaker indicated? 5. Is there any other work up indicated? 6. Where should the patient be admitted to?  
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums