Lyme Carditis Causing Chest Pain and High-Grade AV Block

Lyme carditis can affect the heart’s electrical system.
Chest pain and shortness of breath may signal cardiac complications.
A young woman developed persistent high-grade AV block after Lyme disease.

Lyme carditis can present with chest pain, shortness of breath, heart rhythm abnormalities, and high-grade atrioventricular (AV) block.

Although Lyme carditis is uncommon, it can lead to serious cardiac complications including myocarditis, palpitations, dizziness, syncope, and conduction disturbances.

The young woman was admitted to the emergency department with acute pleuritic chest pain and shortness of breath. Pleuritic chest pain is characterized by sudden sharp, stabbing, or burning pain in the chest when inhaling and exhaling.

The woman exhibited only mild tachycardia (100/min). However, “Considering the suspicion of acute myocarditis, the patient was admitted to an intensive cardiac care unit,” the authors state.

During hospitalization, cardiac monitoring revealed several asymptomatic episodes of paroxysmal AV block, including second-degree Mobitz I AV block, second-degree AV block, and high-grade AV block.

Although there was no evidence of tick exposure or skin lesions, clinicians ordered Lyme disease testing, which was positive by Western blot. “… an IgM Western-Blot test was performed, confirming positivity and recent Borrelia spp. infection.”

The patient was diagnosed with Lyme disease with cardiac manifestations of high-grade AV block. She was treated with a 4-week course of IV ceftriaxone, which led to complete resolution of chest pain and shortness of breath.

Persistent AV Block After Lyme Carditis Treatment

However, the AV conduction disturbance continued after 4 weeks of antibiotic treatment. Subsequently, the woman was given an alternative diagnosis of extrinsic idiopathic paroxysmal AV block (“adenosine-sensitive AV block”).

This could represent an extremely rare course of Lyme carditis, or the patient may have had asymptomatic AV conduction problems that surfaced when she developed Lyme disease, according to the authors.

“The patient was started on theophylline 400 mg twice daily, and after one week of treatment, the Holter monitoring demonstrated a significant reduction in AV conduction disturbances,” the authors state.

At her 18-month follow-up appointment, the woman continued to have fewer AV conduction disturbances, no cardiac complaints, and no need for a permanent pacemaker.

Can Lyme Carditis Cause Persistent Heart Problems?

The authors conclude:

“This case illustrates a challenging scenario of Lyme carditis with high-grade AV block, which persisted after appropriate antibiotic treatment and had key features supporting the diagnosis of extrinsic idiopathic paroxysmal AV block (‘adenosine sensitive AV block’).”

FAQ: Lyme Carditis and Chest Pain

Can Lyme disease cause chest pain?

Yes. Lyme carditis may lead to chest pain, palpitations, shortness of breath, dizziness, or fainting due to inflammation and electrical conduction abnormalities involving the heart.

What is Lyme carditis?

Lyme carditis is a cardiac complication of Lyme disease that can affect the heart’s electrical conduction system and lead to abnormal heart rhythms or AV block.

Can Lyme carditis cause AV block?

Yes. Lyme carditis may cause first-degree, second-degree, or high-grade AV block. Some cases can become severe and require hospitalization or temporary pacing.

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