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.

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] [bctt tweet=”5 things clinicians should know about Lyme carditis.” username=”DrDanielCameron”]

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



  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.

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

  • dawnsterling
    02/02/2024 (8:49 am)

    I have had Lyme for about 15 years and undiagnosed due to poor doctors not believing i had lyme even though I kept telling them. In 2020 i was finally diagnosed, even tho the Lyme tests keep coming back negative per CDC standards. I also have had Rickettsia, Bartonella and Babesia. I was misdiagnosed by a radiologist, neurologist and ophthalmologist for an obscure disease that I don’t even fit, when i actually had meningitis and encephalitis from the Tick Borns, most likely the Babesia, 2 years ago. I now see a neurologist in Boston. I just found a pulmonologist who actually believes in Lyme and sent me for a stress test due to lung issues, including shortness of breath, asthma like symptoms that are not my normal asthma, air hunger and scattered granulomas in my lungs. The stress test came back with rare PVC, brief SVT (around 150bpm, asymptomatic) at rest. Arrhythmias – atrial premature beats. In the stress test is said there was upsloping ST depression inferolateral leads. Can this be a cause of the Lyme disease or coinfections? Should i try to find a cardiologist who believes in Lyme?

    • Dr. Daniel Cameron
      02/04/2024 (8:20 am)

      I have generally had to rely on my local cardiologist to be sure I have not misses a cardiac problem. Some of them are acknowledging POTS. BTW, I have patients with air hunger due to Babesia.

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