When Lyme disease mimics a heart attack

Lyme disease has earned a reputation as the great imitator, because its symptoms can mimic many other illnesses. In a case report, presented by Gilson and colleagues from Easton Hospital in Pennsylvania, a 45-year-old woman was believed to be suffering from a heart attack when, in fact, her symptoms were due to Lyme disease. [1]

 

by Daniel J. Cameron, MD, MPH

According to the authors, Lyme disease mimicked a myocardial infarction (heart attack)  in a 45-year-old woman who presented with a sudden onset of chest pain, radiating to her neck. The evidence supporting a diagnosis of myocardial infarction was strong. A medical workup showed the woman had EKG changes, high admission levels of Troponin and CK-MB, and rising Troponin and CK-MB at 6 hours. Fortunately, the woman’s cardiac catheterization did not show any significant obstructive coronary artery disease.

She was diagnosed with Lyme disease 2 days later after she had developed a right-sided facial palsy. The diagnosis was confirmed by ELISA and positive IgM and IgG antibodies.

Treatment was successful with a combination of intravenous ceftriaxone and oral steroids.

“This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities,” writes Gilson.

The authors point out the difficulties diagnosing atypical manifestations of Lyme disease, stating, “Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers.”

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The authors reminded doctors of the need to include Lyme disease in the differential diagnosis even in patients presenting with clinical symptoms suggestive of acute coronary syndrome.

Related Articles:

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

12-year-old boy suffers cardiac arrest due to Lyme disease

What might sudden cardiac death due to Lyme disease look like?

References:

  1. Gilson J, Khalighi K, Elmi F, Krishnamurthy M, Talebian A, Toor RS. Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction. J Community Hosp Intern Med Perspect. 2017;7(6):363-365.


13 Replies to "When Lyme disease mimics a heart attack"

  • Catherine
    02/18/2018 (3:00 am)
    Reply

    PTLDS is a medical term implying that all medical treatment has failed, and that one’s only hope is to seek alternatives outside the medical system. Chronic Lyme Disease, on the other hand, is acknowledgment of a disease process that proceeds Borrelia infection and by nature of tick biology, may include multiple co-infections. Whether by ongoing infection, immune response, unknown factors or a combination of these, people are still sick and treatments still need to be explored. Please stop calling it post treatment.

    • Dr. Daniel Cameron
      02/18/2018 (8:10 am)
      Reply

      I am not happy with the term either. The 2006 IDSA guideline advised using the PTLDS label for patients still ill with functional limitations after 3 weeks of doxycycline. The term implies that the infection has cleared.

  • Suzie
    02/20/2018 (1:38 pm)
    Reply

    My husband was 59 when he died from Lymes Carditis. All Lymes tests for the month prior were negative. The CDC and Minnesota Department of Public Health confirmed the results after his autopsy.

    • Pam
      02/21/2018 (1:34 pm)
      Reply

      Just wanted to tell you how sorry I am for the loss of your husband. Everything about this disease is horrible, including the lack of support from doctors and insurance companies, dismissal by the media and consequent ridicule from the public. So grateful to the medical professionals, researchers and patients who work tirelessly to change things for the better. Hoping you have some of those people in your life, and that those relationships provide the love and support you deserve.

  • Gretchen Bryan
    03/19/2018 (10:53 pm)
    Reply

    This is how my Lyme story started 3+ years ago. I had symptoms of a heart attack, raised troponin levels. All other cardio test came back that as a 50 year old, I had the cardiovascular system of a 35 year old.
    I still have some palpitations, but my chest pain and back pain have cleared for the most part. My worst symptom is daily horrendous anxiety, major depression, crying jags. Still very scary for me EVERY DAY. Still in treatment.

    • Jen
      10/07/2018 (6:02 pm)
      Reply

      Hello, I have had Lyme for over over 10 years it is believed. I did a short course of abx when I found out, now am
      On herbal treatment. I had a oil set embolism before beginning the herbal treatment last year. A huge history o unexplained chest pains and tachycardia with a near normal cardiac workup other than some what my doc describes as insignificant ekg changes. They won’t even refer me to cardiology again although my symptoms are much the same and unimproved.

      • Dr. Daniel Cameron
        10/07/2018 (8:15 pm)
        Reply

        Doctors differ in how they look at Lyme disease. You should seek a Lyme disease second opinion in addition to followup by a cardiologist.

  • Christine rogers
    08/05/2018 (4:58 pm)
    Reply

    I Was finally diagnosed with lymes disease after going to the er for chills ,fever neck pain in 2016 by my primary care after the erythema rash developed on my knee several days later. I was placed on doxy for 10 days and all was good. Aug 2 2018 I woke with pain in my left shoulder pain , thought I slept wrong I took some aleeve in the morning went to work and still felt the discomfort. I develvedoped chills and thought am I getting lymes again. I had aches and pain in my upper body., pain when taking deep breath also. I went home thinking should I have gone to the er again. I took aleeve again and later had chills took my temp was 100.2 . I had no appetite. I tried to lie down for a while and rest and could not get comfortable at all. The pain in my shoulder and chest when I breathed was getting worse. So at 2 am I drove myself to my local er thinking I was having a heart attack or pulmonary embolism. I was taken quickly ekg no changes my bp was 211/90 hr 90. Labs drawn . All neg except for bnp was 298. Ct for pe was neg but did show Cardiomegaly. Lyme test was neg no rashes.
    The er physician discussed I was not in any life threatening state. I stated to him it must be lymes again , my symptoms were very similar to 2016 except I had no chest pain or shoulder pain.i started on doxy that morning and chest pain and shoulder pain decreased . The pain would flare up and I would take ibproben 600mg every 12 hours and that seem to help a lot. I was able to sleep . I have access to my medical records and reviewed them from my visit in 2016 my chest X-ray showed Cardiomegaly also my crp was 3.9. . I made an appointment to see my primary care in 2 weeks . I am courious what labs should be drawn , should I see a cardiologist? I am also thinking of going to the Lyme research in Valhalla. Any suggestions.

    • Dr. Daniel Cameron
      08/05/2018 (9:15 pm)
      Reply

      You should definitely see a cardiologist. You also should pursue the tick borne infection question. Doctors are divided on their approach to tick borne illnesses. You should weigh the different treatment approaches.

  • Robert Rose
    08/22/2018 (2:40 pm)
    Reply

    I had a tick bite 8 months ago with a cascading rash. I started having a host of symptoms (swollen lymph nodes, left side facial insensitivity including the tongue, tingling in the arms, legs, and back of the head. I have a low body temp 97.5 and had terrible flu like symptoms. I was tested (Quest labs) using Western blot and was negative. I am an avid runner but started having minor chest pains (left side) that have progressively gotten more constant. They do not worsen with exercise. I received an MRI on brain which was negative. I have had 2 EKGs and have also had a stress test with contrast. All negative. All blood work negative. I am taking lisinopril for blood pressure and am on daay 30 of a 42 day doxy regiment. The symptoms have improved significantly with the exception of the chest pain. Any ideas?

    • Dr. Daniel Cameron
      08/22/2018 (4:13 pm)
      Reply

      Thanks for sharing your story. It is very common to end up with a wide range of tests in addition to tick borne illness. It sounds as if your doctor treated you based on clinical judgemnt with modest gains. Antibiotics can lead to chest pain. You should make sure you take probiotics. It is it doxycycline, you may need to take it with food. You will need followup to check to see if you are well. Don’t forget coinfections e.g. Babesia. My comments are meant for discussion and should not be a substitute for your doctor. You will need to work with your doctor.

  • Rosemarie
    09/18/2018 (12:00 am)
    Reply

    Chest pain is so scary. I’ve been to 3 cardiologists and one electrophysiologist and they’ve all cleared me for heart problems. I just hate feeling like they’re missing something. I guess I just have to trust their judgement and the evidence the tests and multiple labs presents. Not sure why I have sharp bursts of chest pain other than lyme disease and co-infections. I absolutley never had palpitations, chest pain or shortness of breath before. Got sick last July and these symptoms began. I am glad I got checked out, both for cardiac and pulmonary issues. I just wish the pain would go away for good.

    • Dr. Daniel Cameron
      09/18/2018 (7:06 pm)
      Reply

      I am glad you do not have cardiac or pulmonary problems. You will likely have to see other doctors including doctors experienced in Lyme disease to try and find a solution.


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