Lyme Endocarditis: A Rare but Serious Cardiac Manifestation
Lyme disease can affect the heart in ways beyond conduction abnormalities, including rare cases of endocarditis involving heart valves.
This case highlights how Lyme infection can mimic more common cardiac conditions—and why it should be considered in the differential diagnosis.
A Severe Valve Presentation
A 68-year-old man presented with progressive shortness of breath and was found to have severe valvular disease.
Transesophageal echocardiography revealed:
- Mitral valve perforation
- Severe mitral valve insufficiency
The patient required mitral valve repair and aortic valve replacement.
Unexpected Diagnosis: Lyme Endocarditis
Despite negative blood and tissue cultures, molecular testing identified Borrelia burgdorferi using 16S rRNA PCR and sequencing.
Other causes of endocarditis were ruled out.
The patient had a history of repeated tick exposure, including bites just weeks before presentation.
Treatment and Outcome
Serologic testing was positive for both IgM and IgG antibodies, consistent with active and prior infection.
The patient was treated with 6 weeks of intravenous ceftriaxone and recovered successfully.
This case demonstrates that even severe cardiac involvement from Lyme disease can respond to appropriate treatment.
How Common Is Cardiac Lyme Disease?
In a review of Lyme carditis cases:
- 69% reported palpitations
- 19% had conduction abnormalities
- 10% had myocarditis
- 5% had left ventricular dysfunction
Valve involvement, such as endocarditis, is rare but increasingly recognized.
Why Lyme Endocarditis Is Difficult to Diagnose
Lyme endocarditis presents with nonspecific symptoms that overlap with other cardiac and systemic illnesses.
According to Paim, “the clinical manifestations are nonspecific and can resemble other infectious and noninfectious diseases.”
Negative cultures can further complicate diagnosis, making molecular testing critical in select cases.
Clinical Takeaway
Lyme disease should be considered in patients with unexplained valvular disease or culture-negative endocarditis, particularly in individuals with tick exposure or outdoor activity in endemic areas.
Although rare, Lyme endocarditis is a treatable condition when recognized early.
Related Articles:
Lyme Myocarditis: Another Cardiac Manifestation
Lyme Carditis and Complete Heart Block
When Lyme Disease Mimics a Heart Attack
References:
- Paim AC, Baddour LM, Pritt BS, Schuetz AN, Wilson JW. Lyme Endocarditis. Am J Med. 2018.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
About 3 years ago, my husband was feeling very sick and at night he would have such heavy night sweats that he used to sleep on beach towels to absorb the perspiration. He saw an internist, was put in the hospital for 4 days, was released and declared healthy. While in the hospital many tests were done and he also saw a urologist, a hematologist, and an infections disease doctor. He was tested for Lyme and it was negative. Not one of his doctors seem to know what we eventually found out, and that is there are 9 tick borne diseases only 3 of which have blood tests. I was desperate. Someone finally recommended Dr. Cameron. We went there with the huge file I had accumulated, he listened, took blood to send to the lab, and put him immediately on antibiotics for 6 weeks. He explained about the 9 tick borne diseases and had seen cases like my husband many times. Even after two weeks on the medicine, my husband was starting to feel better. By the end of the 6 week period, he was 95% recovered. The only reason I even found Dr. Cameron was because I was telling everyone I knew, or met, and even total strangers and finally my Bond broker told me about a Dr. his mother had used. I considered ourselves extraordinarly lucky to have found this man. And I am appalled at how none of the other doctors had a clue.
My daughter has Lyme Disease and has been battling it for 4 yrs. We have to see a holistic doctor out of state as that is the only real help we have found. 8 medical doctors in our area have ridiculed and mistreated, misdiagnosed and humiliated her. Tonight she has chest pains again, and I am worried about her heart. I cannot take her to the local ER because the last time she was there , out of breath with chest pains they just gave her an anti- anxiety and said that many teenage girls go to Lyme doctors who are actually just depressed. If she dies from Lyme in her heart, who in this country would even acknowledge the truth?
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It has to be difficult on your daughter. I am assuming that she had been evaluated by a cardiologist. I often seen adolescents who remain ill despite numerous evaluations. Mood issues are common in Lyme disease as a symptom and not the cause.
I’m not sure if this post is still active. In late June, 2020, I found 4 “poppy seed “sized ticks around my knee. I am not sure how long they were there , but very well attached. I removed them, cleaned the site, and forgot them until an oval 5 inch rash formed around the area. I was also noting pain in my knee, and my daily walks and gardening difficult. I went to see my internal medicine provider. He took a picture of the site, and called it Erythema Migrans. He gave me a prescription for 2 weeks of Amoxicillin 500 mg tid, as I am allergic to Doxy from childhood. He extended the script another 2 weeks, as I had trouble bearing weight on affected knee. I made an appointment with an internal Med doc that also does infectious disease. He told me I had received adequate antibiotics, and would clear eventually. A Lyme AB panel done while I was on ABX, showing 2 positive bands. A third band showed up on a repeat test 1 month later. Meanwhile, my knee swollen and hot. An x ray of knee and fib-tib normal(I am almost 68 and active.) B/c it is 3 months of knee issue, my infectious disease Doc has given me 4 more weeks of ABX. He did not change ABX, and feels it’s not Lyme. My heart sometimes races and pounds, my BP perfect. I hope this tick borne illness is not causing irreversible damage somewhere. I have enjoyed an active lifestyle up to this time. I am amazed in all the confusion on how to treat.
Doctors are divided on how to approach treatment. I have patients who have failed treatment. In some cases, it may be a co-infection that does not respond to amoxicillin. Give my office a call at 914 666 4665 if you have any questions.
I’m a 66 year old male. Had lyme disease. 3 years ago and was treated with doxycycline. Till now no problems. Had an EKG recently and diagnosed with afib and put on eliquis. After 10 days my ankle swelled up and pain when walking. Had an ultrasound and told I have vegetation on mitral valve. Will see heart doctors in January. I’m on doxycycline right now because I feel lyme is affecting my ankle. It’s that or the eliquis. What is your opinion
I would refer a patient with vegetations to the cardiologist now rather than January to look for endocarditis. Endocarditis can lead to valve failure. The swelling can come from heart failure of a calcium channel blocker.