5 things to know about Lyme carditis

Although most people associate Lyme disease with fatigue, joint and muscle pain, fevers and other flu-like symptoms, the illness can also cause serious, debilitating and sometimes, life-threatening symptoms that impact the brain, the lungs and even the heart. The authors of a recent case series, describe "5 things to know about Lyme carditis" to help prevent unnecessary implantation of pacemakers.

 

by Daniel J. Cameron, MD, MPH

Lyme carditis occurs when Lyme spirochete enter the tissues of the heart, causing blockage. Symptoms, which may include lightheadedness, fainting, shortness of breath, heart palpitations, or chest pain, can begin as early as one week after a tick bite. A high-degree atrioventricular block can lead to the need for a permanent pacemaker or in some cases, death.

In the American Journal of Cardiology, Wan, from Queen’s University in Ontario, Canada, lists “5 things to know about Lyme carditis and atrioventricular block.” [1] Having an awareness of these, Wan says, may help prevent pacemakers from unnecessarily being implanted in patients with heart problems caused by Lyme disease.

Lyme carditis occurs when Borrelia burgdorferi, the agent causing Lyme disease, infiltrates the heart tissue.

The listing follows an article published earlier by Wan and colleagues in which they describe five cases of Lyme carditis with high-degree atrioventricular block. The patients were all admitted to Kingston General Hospital in Ontario, Canada. [2]

“5 things to know about Lyme carditis”

  1. Lyme carditis can be an early manifestation of Lyme disease.
  2. Lyme carditis should be considered when younger patients present with severe conduction abnormalities.
  3. Atrial ventricular block in Lyme carditis can progress rapidly and be fatal.
  4. Early treatment with antibiotics may prevent irreversible conduction disease in Lyme carditis.
  5. Before considering implantation of a permanent pacemaker, clinicians should wait for a response to antibiotic treatment for atrioventricular block requiring temporary pacing.

If these points had been considered by the clinicians, 2 of the 5 patients with Lyme carditis may have avoided having a temporary pacemaker implanted. “Temporary pacing was indicated according to hemodynamic tolerance to bradycardias,” explains Wan. [2] Fortunately, none of the patients required a permanent pacemaker.

In addition, treatment delays may have been avoided for 3 of the 5 patients. “The majority of patients (3 out of 5) visited the emergency room multiple times before they were correctly diagnosed,” Wan explains. “Two patients were diagnosed on their second visit. One was recognized on their fourth visit.” [2] 5 things clinicians should know about Lyme carditis. Click To Tweet

Treatment delays may have been avoided if the doctors had made a clinical diagnosis of Lyme carditis in the absence of a tick bite or rash. Only 3 patients remembered a tick bite, and only 1 out of the 5 had an erythema migrans (EM) rash.

All of the patients presented with classic symptoms of Lyme disease including fatigue, fever, headache, neck stiffness, flu-like symptoms, nausea, arthralgia, and/or myalgia.

Clinicians treating children should also be aware of these key points, as 2 of the 5 Lyme carditis cases reviewed by Wan and colleagues involved a 14-year-old and 19-year-old adolescent.

 

Related Articles:

Another cardiac manifestation of Lyme myocarditis

When Lyme disease mimics a heart attack

Lyme carditis causes complete heart block in 26-year-old man

 

References:

  1. Wan D, Baranchuk A. Lyme carditis and atrioventricular block. Cmaj. 2018;190(20):E622.
  2. Wan D, Blakely C, Branscombe P, Suarez-Fuster L, Glover B, Baranchuk A. Lyme Carditis and High-Degree Atrioventricular Block. Am J Cardiol. 2018.

 

 


6 Replies to "5 things to know about Lyme carditis"

  • Kelly-Anne Bryan, RN
    06/24/2018 (11:17 pm)
    Reply

    Lyme and/or Bartonella may not cause obvious carditis or third degree heart block. A more common occurrence is other arrhythmias in otherwise healthy, young patients (and others). I have witnessed this first hand in ten years of nursing practice on a stroke and chest pain unit in a highly endemic area, as well as in my personal experience with these infections. Many times the cardiologist was not considering an infectious cause. Citing my own experience with Lyme, I could advocate in suspicious cases for testing, and educate doctors on testing limitations. Sometimes these patients would turn up positive, and antibiotics were started.
    I have had Lyme and numerous coinfections for about 40 years, misdiagnosed at least 31 years. After 10 years, there were palpitations and occasional episodes of SVT that went unevaluated. I wasn’t a nurse yet, and didn’t realize I needed to see a cardiologist. After about 15 years came additional episodic rapid afib, and transient 1st and 2nd degree blocks. After 20 years came episodes of non-sustained v-tach, potentially life threatening. All from undiagnosed tick infections with no associated heart disease or risk factors. My five children have gestational Lyme. One son has drop attacks that I believe are cardiac related. Due to his mental illness/rage disorder (probably from bartonella), he refuses work up.

    • Jess Bontrager
      11/04/2018 (2:43 pm)
      Reply

      Kelly-Anne, my Lyme disease is starting to affect my heart as well. I am 44 and was diagnosed 5 years ago. I had years of symptoms and attacks before diagnosis. I have had 2 of my 4 children tested because of sickness in both of them. Both are positive. I would have passed it on to them as well. One of my children was treated extensively but it didn’t help her. What advice would you have to offer me regarding the heart? I need to go see a doctor for it. I live in an area with very little knowledge on Lyme Disease. Thank you!

  • Renata chapman
    06/27/2019 (4:31 am)
    Reply

    Oh My Gosh…Im in shock. After years of searching for answers for my daughter..1st diagnosed with Narcolepsy at age 8…and when things started drastically changing for her…more & more symptoms…no one knew what was wrong with her…2 of each Dr endocrinolgist, cardiologists, sleep specialists, pulmonologists, neurologists, neuropsychs, rheumatologists…++++ and Cleveland Clinic….= undiagnosed, its all in your head, no one would believe me..her….and then I found out in a medical report by accident the words munchenhauser by proxy…I cried for days, humiliated, mad and afraid to step foot in another Drs office because now this lie was on the records,,no one took us seriously..endless er visits, and Drs just saying take the 95%of you that is healthy and go to school…to my daughter,, A new internist listened and st appt said she most likely lacked serotonin and put her on Celexa and previously adderall..(which she could never tolerate well)…I waited about another 2 months and found a panda specialist..I was desperate..begging for help…my daughter was not functioning,lost weight…now 20 years old..She listened and ran tests galore…I also took my other daughter now 18 yrs old because she had such bad OCD and anxiety…and she ran tests…Today was result day………….LYMES…BOTH DAUGHTERS.. I had begged for years to have her tested…they wouldnt. and I,the mother (54) have had nonstop pain and swollen knees for 2 yrs…they say its just arthritis….along with a lot of Lymes symptoms…going to Drs tomorrow. and my husband passed away almost 10 yrs ago from an arrhythmia at 51. We lived backed into a forest preserve in Bartlett, Il My husban had lived there for 8 yrs prior to meeting him. He walked that path everyday..coming back with tics on his neck, clothes,,, He was a mech engineer..probably the smartest man alive but even he had no clue how dangerous this all was…I decided to share because I cant believe it, the news I received today…alll the years of advocating for my daughter, all the Drs laughed at me, made me feel like I was crazy…even the most painful insult that I was making my daughter sick,,,I had no idea what muchenhauser by Proxy was…until I read that report 1 yr ago…after reading these comments, the lives of others affected by this horrible disease….being misdiagnosed and getting no help. all the specialists we went to …knew nothing outside their box of specialty ..absolutely no knowledge, no training and a lack of interest …how to connect the dots..how to work with another Dr.. My daughter had 3 consecutive MRIs…because after they wouldnt run the lymes, other auto immune disease tests…I thought maybe its MS. I was all over the board….reading about neurotransmitters, every disease in the book that could possibly be disabling my daughter..She had chronic fatigue, tremors, pain and tingling in her legs, raynauds, misdiagnosed narcolepsy without cataplexy, NFLD(nonalcoholic fatty liver disease) add..unable to focus, finish a project, start a project, major problems with her jaw, teeth..had head gear at age 6, tonsil stones, missed periods, constipation, jus t in the last year she was dxd with overactive bladder, severe allergic reaction to sulfa drug(septra ds/bactrim)..both daughters, the sensation that water was running down her head internally, dizzy all the time, needed to eat several small meals, anxiety attacks, panic attacks, mood swings, pain in her body legs, head, headaches/migraines, chronic yeast…chronic candida, when she was young..I felt she had stopped growing, height, chubby, underdeveloped, within a years time she lost 17lbs not due to any meds at that time…She is now 20 yrs old, 5 foot, 99 lbs….She cant drive because she gets lost and has no focus…she is smart but cant retain what she read…must reread reread. crying overeacting, …plus so much more…Im so dissapointed in how Lymes Disease has not made its way into all Drs textbooks….I will be informing every single Dr we ever saw that laughed at us, made us feel we were making things up so that at least 1 more child, person doesnt go undiagnosed and suffers like my daughter did. This disease has to be taken seriously….My husband is gone from the arrhythemia…I have spent years searching begging…while not one of my daughters but both have Lymes and I put my swollen arthritic knees plus all the other symptoms on the backburner to help my daughter…and to find out all the prev Drs failed her…and our entire family had been suffering from the same disease. That is enough for physicians to be trained in Lymes Disease…it affected my entire family. I thank God for leading us in the right direction, Im grateful for an answer….Now, Im going to go pray ..to figure out what to do next. God Bless all of you.

  • Eileen Donahugh
    08/12/2019 (6:06 pm)
    Reply

    Renatta, I live in West Dundee, Illinois and have been fighting this same battle for 10 years. I have yet to find a doctor to treat me. In this day and age most people would not believe your story or what many of us are dealing with. Unless one has lived it they will never know how difficult life can be with this horrible illness that doctors know nothing about. You’re in my prayers, keep me in yours.

  • Amanda Green
    08/16/2019 (1:12 am)
    Reply

    Same here lots of problems. Basically told it was in my head. Slowly local hospital is learning how to treat me but I am 39. I think after 10 years long term internal organ and brain damage has occurred. The hospital will never admit the dismissed my Lyme suspicions. I am just grateful they finally allowed me the antibiotic that works best for me. However after each “relapse” kinda like MS symptoms it is getting harder to bounce back. Each infection flare up requires more antibiotics and longer hospitalizations. My neurological condition is getting worse and I am getting weaker. I think some serious damage occurred 1.5 years ago. I ain’t dumb I know I am getting weaker. I just wish my family and Drs would be upfront with me.

    • Dr. Daniel Cameron
      08/16/2019 (10:47 pm)
      Reply

      Are there any treatment regimens they overlooked.


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