Lyme Carditis in a Teen: Severe Cardiac Lyme Disease
In this Inside Lyme Podcast, I discuss a dramatic case of Lyme carditis in a 15-year-old boy whose infection caused life-threatening heart rhythm disturbances.
Nawrocki and colleagues first described this case in the Air Medical Journal in 2018.
A 15-year-old boy experienced exertional syncope while at a trampoline park. Syncope refers to a temporary loss of consciousness caused by reduced blood flow to the brain.
The teenager had a history of attention-deficit/hyperactivity disorder but was otherwise healthy.
His friends immediately called emergency medical services, although they were unsure how long he had been unconscious.
When paramedics arrived, the boy appeared pale and unstable. His heart rate was approximately 300 beats per minute. An electrocardiogram (EKG) showed a wide-complex tachyarrhythmia, meaning the heart rhythm was extremely fast and the electrical conduction pattern was abnormal.
[bctt tweet=”Severe Lyme carditis can cause life-threatening heart rhythm disturbances.” username=”DrDanielCameron”]
He received amiodarone, a medication commonly used to treat dangerous heart rhythm disturbances. Despite treatment, the ventricular tachycardia persisted.
At the hospital he remained dizzy and short of breath. His heart rate continued between 290 and 300 beats per minute, and his blood pressure fell to 66/30 mm Hg.
Doctors performed synchronized cardioversion, a procedure similar to electrical defibrillation that delivers controlled electrical energy synchronized with the heart rhythm.
After cardioversion, the EKG changed dramatically and revealed a third-degree heart block. In third-degree heart block, electrical signals from the atria fail to conduct to the ventricles.
Pacing pads were placed immediately.
The boy was then transported by helicopter to a pediatric cardiac intensive care unit at a tertiary care hospital staffed with a critical care flight team.
Even after transfer, he continued to have complete heart block with intermittent rapid rhythms.
Lyme Carditis
Doctors suspected Lyme disease and began intravenous ceftriaxone. Blood tests later confirmed the diagnosis with positive Lyme titers and Western blot testing.
Lyme carditis is a complication of Lyme disease that affects the electrical conduction system of the heart.
Because his heart rhythm remained unstable, doctors inserted a temporary transvenous pacemaker to control the heart rate.
The patient experienced three additional episodes of ventricular tachycardia and required cardioversion twice.
After several days of intravenous antibiotics, the boy’s heart conduction gradually improved and the pacemaker was removed.
He completed a 28-day course of intravenous antibiotics and remained healthy at one-year follow-up.
Conduction abnormalities reported in Lyme carditis include:
- First-degree AV block
- Second-degree AV block
- Complete heart block
- ST-segment and T-wave changes
- Prolonged QT interval
- Junctional tachycardia
In my clinical experience, these severe conduction abnormalities are uncommon in patients who receive early treatment for Lyme disease.
Clinical Lessons From This Case
- Lyme carditis can cause life-threatening heart rhythm disturbances.
- Cardiac conduction abnormalities in Lyme disease can change rapidly.
- Prompt antibiotic treatment can reverse conduction problems.
- Temporary pacemakers may be required in severe cases but can often be removed after treatment.
Treating Tick-Borne Disease in My Practice
In my practice, each patient requires careful clinical assessment. I typically order a broad range of laboratory tests to evaluate for other illnesses in addition to tick-borne infections.
Consultations with other physicians are arranged when necessary.
Many patients with tick-borne illness are medically complex, as highlighted throughout this Inside Lyme Podcast series.
Clinicians evaluating patients with unexplained heart rhythm disturbances should consider Lyme carditis, particularly in regions where tick-borne disease is common.
Inside Lyme Podcast Series
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References:
- Nawrocki PS, Poremba M. A 15-Year-Old Male With Wide Complex Tachyarrhythmia. Air Med J. 2018;37(6):383-387.
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
I cannot believe how fortunate this boy was to have been diagnosed with Lyme, imagine if no one tested him. Sounds like a switched on team of Doctors.
Hello, a bit of history – when I was three I had a bullseye rash (1966) later in high school had bells palsy (1980) and in when I was 31 years old was finally diagnosed with Lyme Disease after suffering for months of unknown random pain that travelled and had bouts of gastric issues and having every possible test under the sun – to find out that I was healthy – until I was in touch with a dr. from Germany who had mentioned to my dr. to run a lyme test and westin blot only to be done at StonyBrook Hospital. Recently had an MRI of my brain and shows white matter due to Lyme. Now at 58 many years later – now pondering the thought of Covid Vaccine and Bells Palsy happening again with some people getting that as a reaction from the vaccine – do you recommend the vaccine at this point for me? I’m on the fence about it and if so which vaccine is best?
I have reluctantly supported the vaccine because of the risk of short and long term complications of COVID-19. I walk my patients though the risks and benefits that work for them.