When It’s Hard to Breathe: Could it be Lyme?

Shortness of breath can feel frightening — especially when it strikes without warning or a clear cause. While heart and lung conditions are common culprits, there’s another, often-overlooked possibility: Lyme disease. This tick-borne infection doesn’t just cause joint pain and fatigue—it can also affect the nervous system, muscles, and even the way your body regulates breathing.

Shortness of Breath: An Often Overlooked Symptom

Many Lyme disease patients describe episodes of shortness of breath. For some, it’s a subtle struggle to take a full breath. For others, it’s chest tightness, air hunger, or a racing heart after climbing stairs. These symptoms are often dismissed but they deserve more careful evaluation.

I’ve found that several conditions can trigger new or worsening shortness of breath such as POTS (Postural Orthostatic Tachycardia Syndrome), Babesia, Lyme carditis, or even immune-mediated respiratory inflammation.

Asking the Right Questions

I’ll always ask:

1. When does the breathlessness occur — at rest, with exertion, or lying down?

2. Are there palpitations, dizziness, or chest discomfort?

3. Is it acute or chronic?

4. Have symptoms changed over time?

5. Is there a history of tick exposure or known Lyme co-infections?

What Shortness of Breath Can Mean in Lyme Disease

Autonomic Dysfunction (POTS)

Shortness of breath in Lyme disease is often linked to POTS. Standing or exertion causes a racing heart and lightheadedness — often mistaken for panic attacks.

Babesia Co-Infection

Babesia can cause air hunger, night sweats, and chest pressure. It’s often underdiagnosed, but treatment can relieve breathlessness.

Lyme Carditis

Patients with Lyme-related heart block or arrhythmia may struggle with shortness of breath doing even basic tasks like walking across the room.

Respiratory Inflammation and Immune Response

Lyme can trigger pulmonary inflammation, phrenic nerve dysfunction, or vocal cord issues. In some cases, the inflammatory response — not direct infection — can impact the lungs, causing: chest tightness, air hunger, mild hypoxia, and non-productive cough.

This is especially common during Herxheimer reactions or in late-stage Lyme.

When to Seek Urgent Evaluation

Breathlessness should never be ignored. Red flags that warrant prompt evaluation include:

• Difficulty breathing at rest

• Inability to lie flat comfortably

• Chest pain or a rapid or irregular heartbeat

• Swelling in one leg (which may signal a blood clot)

• Symptoms that worsen over days or weeks

These signs may indicate serious conditions beyond Lyme disease, such as cardiac, pulmonary, or vascular causes. A medical workup may include oxygen saturation, ECG, chest x-ray, and echocardiogram. Evaluation should begin with your primary care provider and may involve referrals to specialists as needed to rule out life-threatening causes.

The Role of Primary Care in Lyme-Related Dyspnea

Primary care is often where patients first report shortness of breath in Lyme disease. A careful clinical history—especially one that includes tick exposure, co-infection risk, and neurologic symptoms—can change the course of diagnosis.

These symptoms are physiologic, not psychological. A diagnosis of anxiety without a workup misses too many Lyme-related causes.

What Patients Can Do

If you have Lyme disease and are experiencing shortness of breath:

1. Track when and how it occurs

2. Pay attention to posture, exertion, meals, and recovery

3. Ask your provider about POTS, Babesia, or Lyme carditis

4. Advocate for testing if you feel dismissed

5. Don’t assume it’s “just anxiety”

Final Thoughts

Shortness of breath in Lyme disease is real. It may be caused by dysautonomia, co-infections, cardiac issues, or immune reactivity. Treating the root cause, not just the symptom, can restore function and improve quality of life. The right evaluation can be life-changing.

Have you experienced shortness of breath in Lyme disease? Share your story in the comments.

Links

1. When Lyme Treatment Fails: Could It Be Babesia?
2. Lyme Disease Co-Infections: Symptoms, Testing, and Treatment
3. About Babesiosis