Can Lyme Disease Cause Pericarditis and Chest Pain?
Lyme disease pericarditis may cause chest pain and heart symptoms
Cardiac symptoms can appear even with early negative testing
Prompt recognition may reduce serious complications
Lyme disease pericarditis is an uncommon but important complication of Lyme disease that may present with chest pain, palpitations, shortness of breath, and symptoms that resemble other cardiac conditions.
Although Lyme carditis is often associated with heart block, inflammation involving the lining surrounding the heart—called pericarditis—can also occur and may complicate diagnosis.
Patients with chest pain after tick exposure or an unexplained rash may not immediately consider Lyme disease, particularly if early testing is negative.
Several case reports highlight why careful history-taking, exposure assessment, and prompt treatment remain important when evaluating unexplained cardiac symptoms.
What Is Lyme Disease Pericarditis?
Pericarditis refers to inflammation of the thin sac surrounding the heart. Lyme disease pericarditis occurs when cardiac involvement from Borrelia burgdorferi leads to inflammation affecting this protective tissue.
Symptoms can overlap with viral illness, anxiety, musculoskeletal pain, pulmonary disease, or even heart attack symptoms.
Patients interested in broader cardiac complications may also review Lyme carditis.
Case Report: 18-Year-Old Man With Lyme Pericarditis
In the report Lyme-Associated Pericarditis: A Case Report and Literature Review, Ameer and colleagues described an 18-year-old man who presented with severe chest pain related to Lyme disease.
The patient rated his chest pain as 8 out of 10. The pain woke him from sleep and was associated with shortness of breath and palpitations. Symptoms worsened when lying down, taking deep breaths, or coughing.
Leaning forward improved his discomfort—an important clue often seen with pericarditis.
One week before symptom onset, the patient noticed a rash on his back. He did not recall a tick bite but lived in heavily wooded eastern Pennsylvania. Examination revealed an erythematous oval rash with central clearing.
EKG findings supported pericarditis. Despite initially negative Lyme testing, clinicians diagnosed Lyme-associated pericarditis.
His chest pain improved and palpitations resolved following treatment with ibuprofen, colchicine, and intravenous ceftriaxone.
Negative Lyme Testing Does Not Always Exclude Early Disease
The authors emphasized an important clinical point: negative testing early in disease may not exclude Lyme disease.
According to the authors, empiric treatment should be considered when symptoms strongly suggest Lyme-associated cardiac involvement because delayed treatment could increase risk.
These testing limitations reinforce themes discussed in Why Lyme Tests Medicine.
Chest Pain and Lyme Carditis: A Second Case
A second case involved a 45-year-old man admitted with left-sided chest pain after developing fever, headache, neck stiffness, muscle aches, chills, diaphoresis, and nausea.
The patient had hunted three weeks earlier and later noticed an erythema migrans rash that expanded from a bug bite into a target-like lesion.
Clinicians treated him empirically with intravenous ceftriaxone for Lyme carditis. His symptoms resolved following treatment.
This case illustrates how Lyme-related cardiac disease may mimic acute coronary syndromes and other emergency conditions.
Symptoms of Lyme Disease Pericarditis
Symptoms may include:
- Chest pain
- Pain worsening with deep breaths
- Shortness of breath
- Palpitations
- Fatigue
- Lightheadedness
- Worsening symptoms while lying flat
- Relief when leaning forward
Some patients may also experience symptoms overlapping with autonomic dysfunction or persistent symptoms after infection.
Why Lyme Cardiac Disease Can Be Dangerous
Cardiac involvement from Lyme disease may occasionally progress beyond pericarditis.
Potential complications include:
- Heart block
- Conduction abnormalities
- Arrhythmias
- Pericardial effusion
- Rare life-threatening complications
Patients with chest pain and concerning symptoms should seek medical evaluation promptly.
Frequently Asked Questions
Can Lyme disease cause pericarditis?
Yes. Lyme disease can rarely cause inflammation of the tissue surrounding the heart, leading to pericarditis.
Can Lyme disease cause chest pain?
Yes. Chest pain may occur with Lyme carditis, pericarditis, autonomic dysfunction, or other cardiac complications.
Can Lyme disease cause heart palpitations?
Yes. Some patients with Lyme-related cardiac involvement experience palpitations or abnormal heart rhythms.
Can Lyme testing be negative with cardiac symptoms?
Yes. Early Lyme disease testing may be negative despite compatible symptoms.
Is Lyme pericarditis dangerous?
Although uncommon, untreated cardiac involvement may occasionally lead to serious complications.
Clinical Takeaway
Lyme disease pericarditis is uncommon but may present with chest pain, palpitations, and symptoms that mimic other cardiac conditions.
Early Lyme testing may be negative despite clinically significant disease.
Chest pain after tick exposure, rash, or compatible symptoms warrants careful evaluation for possible cardiac involvement.
Related Articles
These articles explore cardiac complications and overlapping symptoms related to Lyme disease.
Lyme Carditis
Young Adults Most at Risk for Lyme Carditis
Autonomic Dysfunction and Lyme Disease
Persistent Lyme Disease Symptoms
Lyme Disease Symptoms Guide
References
- Ameer MA, Patlolla SR, Patel N, Mehta R, Babar M. Lyme-Associated Pericarditis: A Case Report and Literature Review. Cureus. 2024;16(2):e54096.
- Michalski B, et al. Lyme Carditis Buried Beneath ST-Segment Elevations. Case Rep Cardiol. 2017.
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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
