What might sudden cardiac death due to Lyme disease look like?

What might sudden cardiac death due to Lyme disease look like?

"Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity," according to researchers who describe their findings from an autopsy study on 5 case patients who died from sudden cardiac death and were found post mortem to have Lyme carditis. The cases are discussed in an article entitled Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis, published in The American Journal of Pathology.

by Daniel J. Cameron, MD MPH

Fatal Lyme carditis is rarely identified. In reviewing five post mortem cases, Muehlenbach and colleagues found that Lyme disease was not suspected for one patient who complained of episodic shortness of breath, while the second patient tested negative for Lyme disease. Two other patients did not seek medical care. Details regarding the fifth patient were not released.

Ultimately, two case patients were diagnosed during unexplained-death investigations at the Centers for Disease Control and Prevention (CDC). Lyme disease was suspected in two of the other cases by cardiac pathology at a tissue bank transplant service. Muehlenbachs and colleagues reassure the readers that cardiac tissue was not transplanted. [1]

Autopsies reveal several findings

Spirochetes were present in the heart on all 5 cases. When using immunohistochemistry (IHC), spirochetes were found “within the myocardial interstitial infiltrates, in the subendocardium, and occasionally in pericardial tissue in association with lymphohistiocytic infiltrates.” Muehlenbachs adds, “Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry.”

All 5 cases lived in Lyme-endemic areas. Patients resided in counties with a high or moderate incidence of Lyme disease including, New York, New Hampshire (with recent travel to Connecticut), Massachusetts and Indiana.

All 5 cases reportedly engaged in outdoor activities. “Two patients had known exposure to ticks, and one patient reported a recent bite.”

None of the 5 cases met the CDC surveillance case definition for Lyme carditis. This definition includes: recurrent, brief attacks (weeks or months) of objective joint swelling in one or several joints; lymphocytic meningitis; cranial neuritis; radiculoneuropathy; encephalomyelitis; acute onset of high-grade (2nd-degree or 3rd-degree) atrioventricular conduction defects, and myocarditis.

Only 1 of the 5 cases underwent serologic screening for Lyme disease and the results were negative.

All 5 cases were symptomatic prior to their death. “A prodrome was reported for each of the patients that included the following: non-specific viral-like illness, malaise, shortness of breath, and anxiety,” according to Muehlenbachs. “One of these patients also had joint and muscle pain, and the other two patients had joint pain for an unknown duration.”

“No dermatologic lesion was documented or reported for any of the patients, although one patient was evaluated in an emergency department 1 month before death for an arm lesion diagnosed as a possible spider bite from which methicillin-resistant Staphylococcus aureus was isolated in culture.”

“Providers should consider Lyme disease in patients who have cardiac symptoms and exposure in an endemic area.” [1]

All 5 cases were seropositive post mortem according to the CDC’s two-tier criteria. “One sample met both IgM and IgG Western Blot (WB) criteria, with two of the three IgM bands and 6 of the 10 IgG bands reactive. The four remaining samples were positive by IgM WB criteria only, although three were nearly IgG positive with 4 of the 10 bands reactive,” states Muehlenbachs.

Underlying cardiac disease may have played a role in 3 of the 5 cases of sudden cardiac deaths associated with Lyme disease, Muehlenbachs points out, since there was significant underlying heart disease present in two patients, and an additional patient had moderate atherosclerosis, discovered at autopsy.

Physiological cardiac stress was considered a potential factor in 2 of the 5 cases. “In the other two patients, who were otherwise healthy, a degree of physiological cardiac stress likely was present: the woman had given birth 6 months previously and the man was a physically active outdoor enthusiast,” according to Muehlenbachs.

These pathologic findings provide insight into the possible cause behind sudden cardiac deaths associated with Lyme disease. “The findings support the proposed disease mechanism of spirochete cardiac tropism during early disease dissemination, the infiltration of cardiac tissue by inflammatory cells, and involvement of the conduction system, which likely mediates sudden cardiac death.” [1]

Is early diagnosis and prompt treatment possible?

“Early diagnosis and prompt treatment for Lyme carditis can be life-saving,” according to Muehlenbachs. “Health care professionals should evaluate all patients with suspected Lyme disease for cardiac signs and symptoms, and obtain an electrocardiogram promptly if carditis is suspected.” Furthermore, “diagnosis is based on clinical suspicion and serologic testing, with the caveat that serology testing may be falsely negative in a patient with recent illness onset.” [1]

Fishe and colleagues describe how early diagnosis and treatment helped save the life of a 15-year-old African-American girl with Lyme carditis. [2] The patient was hospitalized after a 3-day history of intermittent retrosternal and epigastric pain. After treatment was initiated, she developed a heart block. Tests for Lyme disease were positive and she was diagnosed with Lyme disease-associated myocarditis.

The adolescent was empirically started on doxycycline and was concurrently treated with milrinone infusion for afterload reduction and intravenous furosemide for pulmonary edema. Her EKG changed to first-degree heart block by day 2 and resolved completely on hospital day 3.

She recovered and was discharged home on hospital day 7 on oral furosemide, enalapril, and doxycycline, according to Fishe and colleagues.

However, another adolescent was not so fortunate. He died suddenly from undiagnosed Lyme carditis, following complaints of flu-like symptoms. The case is discussed in another All Things Lyme blog, Relying on a Negative Lyme Disease Test Can Prove Deadly.

“In patients with Lyme disease who complain of cardiopulmonary symptoms, clinicians should have a low threshold for obtaining an EKG to evaluate for Lyme carditis,” Fishe points out. Furthermore, clinicians should take note that in “children and adolescents, respiratory and gastrointestinal complaints, with or without chest pain, are the most frequent presenting symptoms.”


  1. Muehlenbachs A, Bollweg BC, Schulz TJ et al. Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. Am J Pathol, (2016).
  2. Fishe JN, Marchese RF, Callahan JM. Lyme Myocarditis Presenting as Chest Pain in an Adolescent Girl. Pediatr Emerg Care, (2016).

25 Replies to "What might sudden cardiac death due to Lyme disease look like?"

  • Florence
    03/29/2023 (11:15 am)

    Is it possible after having an ecg to be told you have a healthy heart although it has electrical issues that create occasional pacs and pvcs and an atrial tachycardia? Reason I ask is I treat Lyme with rife and my heart rhythm is normal apart from occasional episodes of the aforementioned and I’m concerned that this is a more serious problem for me. I’ve seen a cardiologist (EP) for 20+ yrs, had an ablation for a former svt and was told heart issues such as carditis are early stage?

    • Dr. Daniel Cameron
      04/01/2023 (7:10 am)

      I have Lyme disease patients who have palpitations and PVC’s yet nothing shows up on an EKG or ECHO for a cardiologist. I have found that Lyme carditis can show up in early disease as a heart block. But I do not se the range a cardiologist sees.

  • Jeffrey mcmahon
    11/19/2021 (10:58 am)

    I was diagnosed with severe lymes meningitis 5 months ago, after 5 weeks of antibiotics the symptoms associated with the meningitis where gone, yet a combination of very frequent pvc(more than 20% of all my heart beats) and pots syndrome emerged. My heart rate is often very high and fatigue and brain fog common. Though I’ve had heart mri and cat scan and ultrasound that say my heart is physically normal…My symptoms are slowly getting worse. Ideas? Many many thanks. Jeffrey

    • Dr. Daniel Cameron
      11/19/2021 (12:35 pm)

      I do not typically find cardiac problems by heart MRI, CT or ECHO in my practice yet they can still have autonomic related illnesses including POTS. I look a second time for a persistent tick borne infection. Call my office at 914 666 4665 if you have any questions.

  • patricia d carter
    07/06/2020 (11:42 pm)

    My son, 37 years old, just recently diagnosed with five bands of lyme. He is having heart palpitations and runs. We have seen a cardiologist before diagnose. Are the PVC’s considered dangerous?

    • Dr. Daniel Cameron
      07/07/2020 (7:03 am)

      Many Lyme disease patients in my practice have palpitations. A few have PVC’s. I rely on the cardiologist to determine if a PVC is an issue. I also make sure to look closely for evidence of a persistent tick-borne infection.

  • Jenny
    01/17/2020 (7:45 pm)

    My mom passed away suddenly at the age of 53. The week before her death she had flu like symptoms. A year and a half before her death she was positive with lymes after finding a bullseye on her stomach. Since that time, after antibiotics the tests came back negative. They lived in CT in a heavily wooded area. Her autopsy came back:unknown. In my heart I believe she passed away from lymes. When I called to ask questions about autopsy my calls were never returned. It has been almost 16yrs without her, my best friend & I can’t help but wonder everyday if this could have been prevented? Who can I ask these questions too?…What can I do to help prevent something like this happening to someone else in the future?

    • Dr. Daniel Cameron
      01/17/2020 (8:04 pm)

      It is always difficult to determine whether a tick-borne infection is present after the fact. It is worse when the person is reluctant to seek help. I have patients who are reluctant to seek help.

      • SM
        02/08/2020 (4:45 pm)

        I believe patients are reluctant to seek help after they have been turned away many times because medical staff either can’t find a reason for their symptoms, or the patient has been made to feel that it is “all in their head”. Better testing is needed in North America and should be first line of defense when seeking help. It is awful when presenting symptoms to the doctor and knowing in your heart that something is wrong, and being dismissed because you may not fit neatly into the box of what symptoms you are “supposed to have”…ie. bullseye rash. (not always present).

  • Stacy L Stuenzi
    01/12/2020 (7:14 pm)

    When someone passes unexpectedly, or not, with heart related issues, would it be routine to check for Lyme or is it something that would be an obvious thing to determine when looking at a heat postmortem? Would family need to ask for Lyme to be looked for? Two family friends have passed away from heart issues after being told “there is nothing wrong.” One was an 18 year old boy; the other a 46 year old woman. I am always curious when “there is nothing wrong” if Lyme could have played (or is playing) a part. It concerns me, as I was “treated” for Lyme 6 years ago (a 30 day doxycycline routine- never retested) and have chest pain, but got checked and told “there is no issue.” I have been learning much about Lyme through your site, and appreciate the information. Thank you for spearheading the research and pushing the importance of Lyme knowledge.

    • Dr. Daniel Cameron
      01/13/2020 (9:04 am)

      I have not seen Lyme checked after death on a routine basis. Lyme carditis has been documented on autopsy. Lyme carditis manifesting as a conduction problem would not evident on autopsy. Also, autopsies are often not performed.

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