Can Lyme Disease Be Fatal? Three Deaths Associated With Lyme Carditis
Lyme carditis is a rare but potentially life-threatening complication of Lyme disease.
Heart rhythm abnormalities may cause fainting, heart block, or, rarely, sudden cardiac death.
Early recognition, ECG evaluation, and antibiotic treatment can dramatically improve outcomes.
Many people ask whether Lyme disease can be fatal. Although death from Lyme disease is uncommon, Lyme carditis can occasionally disrupt the heart’s electrical conduction system and, in rare cases, lead to sudden cardiac death. These CDC cases illustrate why recognizing cardiac symptoms early is critical. Prompt diagnosis and treatment can prevent serious complications in most patients.
Lyme carditis is estimated to occur in approximately 1% of reported Lyme disease cases, although the true frequency may vary. Most patients recover completely with appropriate antibiotic therapy, particularly when the condition is recognized early. Individuals living in or traveling through endemic areas who develop unexplained cardiac symptoms should also be evaluated for other Lyme disease symptoms that may support the diagnosis.
I first read about these cases in the Morbidity and Mortality Weekly Report (MMWR) published by the CDC.
The report described three sudden deaths associated with Lyme disease. All three individuals were diagnosed with Lyme carditis during autopsy, highlighting the potentially serious consequences of an unrecognized cardiac complication.
Massachusetts Case
In November 2012, a Massachusetts resident was found unresponsive in an automobile after it veered off the road. Emergency responders found no cardiac activity, and the patient was pronounced dead at a nearby hospital.
Interviews with family members revealed that the patient had experienced a nonspecific illness during the previous two weeks, including malaise, muscle aches, and joint pain. The patient lived alone with a dog that reportedly brought ticks into the home frequently.
Autopsy findings confirmed Lyme carditis.
New York Case
In July 2013, a New York resident developed chest pain and suddenly collapsed at home. Cardiopulmonary resuscitation was unsuccessful.
The patient had a history of Wolff-Parkinson-White (WPW) syndrome, a condition involving an abnormal electrical pathway that can predispose individuals to rapid heart rhythms. There was no documented history of a tick bite or erythema migrans rash. Although WPW complicates interpretation of the case, autopsy findings confirmed Lyme carditis as an important contributor to the patient’s fatal illness.
Connecticut Case
In July 2013, a Connecticut resident collapsed while visiting New Hampshire and was pronounced dead at a local hospital.
During the preceding 7 to 10 days, the patient had reported episodic shortness of breath and anxiety. The day before death, clonazepam was prescribed for presumed anxiety. No electrocardiogram (ECG) was obtained during this evaluation.
Autopsy confirmed Lyme carditis.
All three individuals tested positive for Lyme disease following autopsy.
Why These Cases Matter
Lyme carditis develops when Borrelia burgdorferi affects the heart’s electrical conduction system. The most common abnormality is atrioventricular (AV) block, which can fluctuate rapidly over hours or days. Patients may experience fatigue, lightheadedness, palpitations, chest discomfort, shortness of breath, or syncope before developing more serious conduction abnormalities.
Patients with suspected Lyme carditis should undergo an electrocardiogram (ECG) to evaluate for AV block or other conduction abnormalities. Because heart block can progress rapidly, repeat ECGs or continuous cardiac monitoring may be necessary when clinical suspicion remains high. A careful history, physical examination, and appropriate diagnostic evaluation for Lyme disease can help guide treatment decisions.
Fortunately, most patients with Lyme carditis recover completely with appropriate antibiotic treatment. Temporary cardiac pacing may occasionally be required for patients with advanced heart block, but permanent pacemakers are often unnecessary because conduction abnormalities usually resolve after the infection is treated.
These three cases illustrate how nonspecific symptoms may delay recognition of Lyme carditis. Maintaining a high level of clinical suspicion in patients from endemic areas who develop unexplained chest pain, palpitations, dizziness, fainting, or shortness of breath remains essential, particularly when there has been possible tick exposure or other features consistent with Lyme disease.
Questions These Cases Raise
These tragic cases raise several important clinical questions for physicians and patients alike.
- What is Lyme carditis, and how does it affect the heart’s electrical conduction system?
- How often does Lyme carditis occur in patients with Lyme disease?
- What symptoms should prompt an electrocardiogram (ECG) in someone with possible Lyme disease?
- Can Lyme carditis be prevented through earlier recognition and treatment of Lyme disease?
- How frequently are autopsies performed after sudden unexplained cardiac death?
- What role, if any, did Wolff-Parkinson-White syndrome play in the second patient’s death?
- How reliable is Lyme disease testing when performed after death?
- Could earlier ECG testing have identified heart block in the third patient before the fatal event?
- Why was the history of frequent tick exposure through the patient’s dog clinically important?
- What practical lessons can clinicians and patients learn from these cases?
Frequently Asked Questions
Can Lyme disease be fatal?
Death from Lyme disease is rare. However, Lyme carditis can interfere with the heart’s electrical conduction system and, in uncommon cases, lead to life-threatening arrhythmias or sudden cardiac death if left unrecognized.
What is Lyme carditis?
Lyme carditis is a cardiac manifestation of Lyme disease in which Borrelia burgdorferi affects the heart’s electrical conduction system. The most common finding is atrioventricular (AV) block, although other rhythm disturbances may occur.
Can Lyme disease affect the heart without causing a rash?
Yes. Some patients with Lyme carditis never recall a tick bite or develop the classic erythema migrans rash. Cardiac symptoms may be the first recognized manifestation of Lyme disease.
What symptoms should raise concern for Lyme carditis?
Chest pain, palpitations, dizziness, fainting, unexplained shortness of breath, lightheadedness, or exercise intolerance—particularly after possible tick exposure—should prompt medical evaluation and consideration of an ECG.
Can Lyme carditis be treated?
Yes. Most patients recover completely with prompt antibiotic treatment. Hospitalization and temporary cardiac pacing may be necessary for patients with advanced heart block until normal conduction returns.
Should everyone with Lyme disease have an ECG?
No. An ECG is generally recommended for patients with Lyme disease who develop cardiac symptoms or who are suspected of having Lyme carditis. The decision should be individualized based on the clinical presentation.
Clinical Takeaway
These three CDC cases demonstrate that Lyme carditis, although uncommon, can have devastating consequences when it goes unrecognized. Patients from Lyme-endemic regions who develop chest pain, palpitations, dizziness, fainting, or unexplained shortness of breath should be evaluated promptly, particularly if there is a history of possible tick exposure or other symptoms consistent with Lyme disease.
Early recognition, ECG evaluation, and prompt antibiotic treatment can prevent most serious complications of Lyme carditis and lead to excellent outcomes for the vast majority of patients.
Related Articles
Lyme Carditis: Symptoms, Diagnosis, and Treatment
Can Lyme Disease Cause Atrial Fibrillation?
How Lyme Disease Is Diagnosed: A Practical Guide
How Often Is Lyme Disease Misdiagnosed?
Delayed Lyme Disease Treatment and Long-Term Outcomes
References
- Centers for Disease Control and Prevention (CDC). Three Sudden Cardiac Deaths Associated With Lyme Carditis — United States, November 2012–July 2013. MMWR Morb Mortal Wkly Rep. 2013;62(49):993-996.
- Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the IDSA, AAN, and ACR: 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021;72(1):e1-e48.
- Besant G, Wan D, Yeung C, et al. Suspicious Index in Lyme Carditis: Systematic Review and Proposed New Risk Score. Clinical Cardiology. 2018;41(12):1611-1616. doi:10.1002/clc.23102.
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
My son is 21 with episodes of sudden tachycardia and SVT on EKG. History of POTS yet high BP upon exam, 159/110. Has Bartonella, Babesia, Chronic EBV,. Please advise. Beta blocker as needed helps but only Lyme people get it. Is there a Lyme literate cardiologist in existence?
I do not know of any cardiologist that would be Lyme literature. I rely on cardiologist in my area to look at my patients and I take care of their Lyme disease. There are POTS doctors.
I have been having severe chest pains for about 6 mos. I had a CT scan that showed an ascending aortic aneurysm at 4.2. (I believe caused by Lyme)
Now I am having extreme palpitations and on a 72 hour monitor it shows an extra 300 beats per hour PAC’s. I can’t sleep at night because the palps are so strong that I constantly feel them. The chest pain goes from just below collar bone to right above breast. I had an elevated CRP-Cardiac at 7.19. The range is 0-3. I am so concerned about Lyme causing this and I can’t tolerate antibiotics. Any suggestions?
There are so many causes for your cardiac problems. I have patients who never find a cause. I lean on my cardiac colleagues to help me manage cardiac issues. The cardiologist may find another cause or at least manage the cardiac problems you described.