Questions to Ask Patients About Lyme Disease in Cardiac Cases
Lyme disease may present with cardiac symptoms that resemble more common conditions. A case of arrhythmia highlights the importance of asking targeted questions about possible tick exposure.
This raises an important question: when should Lyme disease be considered in patients with cardiac abnormalities? Clinical context and exposure history may provide important clues.
A 51-year-old man in the United Kingdom was hospitalized with retrosternal chest pain. He had a history of palpitations, dizziness, sweating, and a prior transient ischemic attack.
He presented with a heart rate of 180 and findings consistent with fascicular ventricular tachycardia. He was treated with adenosine followed by amiodarone, successfully restoring normal sinus rhythm.
Could Lyme Disease Be Involved?
In a letter to the editor, an infectious disease specialist emphasized the importance of considering Lyme disease in similar cases.
“At what time of year did he develop the arrhythmia? If he had dogs or enjoyed the outdoors, might he have Lyme carditis due to Borrelia spirochetes?” writes Murray-Leisure.
Key Questions to Ask Patients
When evaluating patients with unexplained cardiac findings, clinicians may consider asking:
- When did your symptoms begin, and during what season?
- Have you spent time outdoors in wooded or grassy areas?
- Do you have pets that may carry ticks?
- Have you noticed a rash or flu-like illness in recent weeks?
- Have you traveled to an area where Lyme disease is common?
Implications for Treatment
If Lyme disease is suspected, treatment decisions may differ. In addition to managing arrhythmias, patients may require antibiotic therapy such as intravenous ceftriaxone followed by oral doxycycline.
This case highlights how identifying Lyme disease as an underlying cause could change management.
Clinical Perspective
This report underscores the importance of considering Lyme disease in patients with unexplained cardiac symptoms, even when presentations resemble common cardiac conditions.
Including targeted questions about exposure history may improve recognition of Lyme carditis.
Patients may benefit from review of Lyme disease symptoms, understanding testing limitations, and awareness of coinfections in complex presentations.
References
- Lim VG et al. Fascicular ventricular tachycardia case. Am J Med. 2016.
- Murray-Leisure K. Lyme carditis considerations. Am J Med. 2017.
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
