Lyme Disease Heart Problems After Treatment

Heart complications can occur after Lyme disease treatment.
Symptoms may include chest pain, palpitations, or shortness of breath.
Lyme carditis can occasionally involve rare neurologic complications.

A 49-year-old man developed significant cardiac problems one month after being diagnosed and treated for Lyme disease with a 10-day course of doxycycline.

The man was an avid hiker who frequently visited trails in Pennsylvania, wrote Palmer and colleagues in their article “Atrial Flutter and Left Hemidiaphragmatic Paralysis in the Setting of Lyme Disease.” [1]

Although he initially “overall felt better after taking the antibiotics,” he later presented with chest pain and shortness of breath that had persisted for two weeks.

---

Lyme Disease Heart Symptoms

The patient appeared in acute distress with rapid breathing and a heart rate of 169 beats per minute.

An EKG demonstrated atrial flutter with rapid ventricular response.

Because of concern for Lyme carditis causing tachyarrhythmia, physicians started intravenous ceftriaxone therapy. [1]

Atrial flutter is a type of abnormal heart rhythm in which the upper chambers of the heart beat too rapidly. [2]

The patient was later transitioned to an additional 17 days of doxycycline treatment.

---

Rare Neurologic and Cardiac Complications

During hospitalization, fluoroscopic chest sniff testing confirmed left hemidiaphragmatic paralysis.

The patient was ultimately diagnosed with:

• atrial flutter
• Lyme carditis
• left hemidiaphragmatic paralysis

Hemidiaphragmatic paralysis is considered a rare complication of Lyme disease. According to the authors, the first reported case was documented in 1986, with only a limited number of additional cases described since then. [1]

---

Treatment and Recovery

The patient’s atrial flutter resolved after treatment with IV metoprolol, oral metoprolol tartrate, and IV diltiazem.

However, the authors were unable to determine whether the initial 10-day antibiotic course contributed to the later cardiac complications.

They also could not determine whether treatment longer than 21 additional days would have improved the patient’s hemidiaphragmatic paralysis.

---

Lessons From the Case

The authors emphasized several important clinical points:

• hemidiaphragmatic paralysis should be considered a possible complication of Lyme disease
• atrial tachyarrhythmias such as atrial flutter can occur during Lyme disease
• clinicians should consider both cardiac and neurologic complications in patients from Lyme-endemic areas

This case also highlights that some Lyme disease patients may continue to develop symptoms even after an initial course of antibiotic therapy.

---

Clinical Perspective

Lyme disease can occasionally lead to serious cardiac complications including palpitations, tachyarrhythmias, chest pain, shortness of breath, or Lyme carditis.

Although heart block is the most recognized cardiac manifestation, atrial flutter and rare neurologic complications such as hemidiaphragmatic paralysis have also been reported.

Persistent or worsening cardiac symptoms after Lyme disease treatment warrant careful medical evaluation.

---

---

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