Lyme Carditis With Heart Block Can Require Multiple Hospital Visits
Lyme carditis may present with dizziness, fainting, and heart block
Tick bites and erythema migrans are often absent
Early antibiotic treatment can help prevent unnecessary pacemaker implantation
Lyme carditis can cause complete heart block, dizziness, fainting, and other nonspecific symptoms that may be mistaken for more common cardiac conditions. In this Canadian case series, most patients required multiple hospital visits before Lyme carditis was recognized and treated.
Lyme carditis is a potentially reversible cause of heart block, but diagnosis is often delayed because patients may not recall a tick bite or develop the classic erythema migrans rash.
Lyme carditis with heart block can be challenging to diagnose. But, “recognizing this early would curtail the progression of conduction disorders and potentially avoid permanent pacemaker implantation,” states lead author Wan from Queen’s University in Ontario, Canada.
Why Lyme Carditis Can Be Missed
The majority of patients (3 out of 5) visited the emergency room multiple times before they were correctly diagnosed. Two patients were diagnosed on their second visit, while one was not recognized until a fourth visit.
According to Wan, “Three patients presented complete AVB whereas the other 2 developed second-degree atrioventricular block with 2:1 conduction.”
The authors note that Lyme carditis can be difficult to recognize because many patients lack classic Lyme disease findings. Only three patients recalled a tick bite, and only one developed an erythema migrans rash. All five patients, however, experienced symptoms commonly associated with Lyme disease symptoms, including fatigue, fever, headache, neck stiffness, flu-like symptoms, nausea, joint pain, and muscle aches.
“The absence of pathognomonic EM, presentation with nonspecific symptoms and involvement of various systems, all can potentially distract a physician from making the correct diagnosis at initial presentation,” the authors warn.
Lyme Carditis and High-Degree Heart Block
None of the five patients required a permanent pacemaker. However, two individuals did require temporary pacing because of symptomatic bradycardia.
“Temporary pacing was indicated according to hemodynamic tolerance to bradycardias,” explains Wan. Echocardiograms identified abnormalities in two patients, including mild right ventricular dilation in one case and focal myocarditis with diastolic dysfunction in another.
Heart Block Resolved After Antibiotic Treatment
Four patients were treated with intravenous ceftriaxone until their conduction abnormalities improved and were then transitioned to oral antibiotics. The fifth patient was treated with doxycycline.
All five patients experienced resolution of their conduction abnormalities within 1 to 2 weeks after starting antibiotic therapy. None required a permanent pacemaker, highlighting the importance of recognizing Lyme carditis before irreversible interventions are considered.
Who Was Affected?
Interestingly, all five cases involved males younger than 35 years of age. The youngest patient was a 14-year-old boy. Each patient participated in outdoor activities in a Lyme-endemic region.
The findings illustrate how Lyme disease misdiagnosis can occur when clinicians focus on cardiac symptoms without considering a tick-borne illness. Early recognition and treatment may reduce complications, shorten hospital stays, and help patients avoid unnecessary procedures.
“The correct diagnosis,” the authors point out, “may save patients from the inherent risks of pacemaker implantation, possible late complications, a lifetime of multiple pulse generator changes, and the burden of associated cumulative health care costs.”
Frequently Asked Questions
Can Lyme disease cause complete heart block?
Yes. Lyme carditis can affect the heart’s electrical conduction system and lead to first-degree, second-degree, or complete heart block.
Does Lyme carditis always require a pacemaker?
No. Many patients improve with antibiotic treatment alone. Temporary pacing may be needed in severe cases, but permanent pacemakers can often be avoided when Lyme carditis is recognized early.
What are symptoms of Lyme carditis?
Symptoms may include dizziness, fainting, palpitations, fatigue, chest discomfort, shortness of breath, or signs of heart block. Many patients also have flu-like symptoms associated with Lyme disease.
How quickly does Lyme carditis improve with antibiotics?
In this case series, conduction abnormalities resolved within 1 to 2 weeks after antibiotic treatment was started.
Clinical Takeaway
Lyme carditis may present with nonspecific symptoms and heart block, leading to repeated hospital visits before the correct diagnosis is made. In this Canadian case series, all five patients recovered after antibiotic treatment, and none required a permanent pacemaker. The findings underscore the importance of considering Lyme disease in patients with unexplained conduction abnormalities, especially in endemic regions.
Related Articles
Lyme carditis causes complete heart block in a 26-year-old man
Temporary pacemaker effective in acute Lyme carditis patient with severe heart block
When Lyme disease mimics a heart attack
Lyme carditis: symptoms, diagnosis and treatment
References
- Wan D, Blakely C, Branscombe P, Suarez-Fuster L, Glover B, Baranchuk A. Lyme Carditis and High-Degree Atrioventricular Block. Am J Cardiol. 2018.
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
