Lyme Disease and Chest or Abdominal Pain: Gallbladder vs. Carditis Explained
Chest pain or gallbladder pain?
Lyme disease can mimic both heart conditions and abdominal disorders—especially in adolescents.
Yes—Lyme disease can mimic gallbladder pain and can also affect the heart (Lyme carditis or myocarditis).
These overlapping symptoms can make diagnosis challenging, especially when patients present with chest discomfort, abdominal pain, or abnormal cardiac findings. Patients may also experience a wide range of Lyme symptoms that evolve over time.
Can Lyme Disease Cause Gallbladder Symptoms?
Yes. Lyme disease can present with abdominal pain that mimics gallbladder disease, including right upper quadrant pain, a positive Murphy sign, or imaging findings suggestive of cholecystitis.
In some cases, these symptoms are not due to primary gallbladder disease but are part of a broader inflammatory or cardiac process such as Lyme myocarditis.
What Is Lyme Carditis?
Lyme carditis is a complication of Lyme disease in which the infection affects the heart, leading to inflammation and electrical conduction abnormalities.
This can result in heart block, abnormal heart rhythms, chest pain, or shortness of breath.
Carditis Meaning in Lyme Disease
Carditis means inflammation of the heart. In Lyme disease, this inflammation can interfere with the heart’s electrical system and lead to conduction abnormalities or rhythm disturbances.
Does Lyme Carditis Affect Troponin Levels?
Lyme carditis can raise troponin levels, a marker of heart muscle injury.
Elevated troponin levels may indicate myocarditis rather than a primary abdominal condition such as gallbladder disease.
Can Lyme Carditis Be Dangerous?
Yes. Lyme carditis can be serious and, in rare cases, life-threatening.
The CDC has reported cases of sudden cardiac death associated with untreated Lyme carditis.
However, with early recognition and appropriate treatment, most patients recover fully.
Case: Lyme Myocarditis Presenting as Chest and Abdominal Pain
This case demonstrates how Lyme disease can initially be mistaken for gallbladder disease before cardiac involvement is recognized.
In a case reported in Pediatric Emergency Care, a previously healthy adolescent presented with a three-day history of severe chest and abdominal pain.2
The pain was described as “gnawing” and “twisting,” affecting both the sternum and right upper quadrant.
Initial evaluation suggested possible gallbladder disease, including abnormal liver function tests, bile duct dilation, and a positive Murphy sign.
However, further testing revealed cardiac involvement. Electrocardiography showed conduction abnormalities, and troponin levels were markedly elevated at 15.81 ng/mL—consistent with myocardial injury.
The patient developed second-degree heart block and hypotension, raising concern for myocarditis.
Lyme disease was considered early, and the patient was treated empirically with doxycycline. Her condition improved rapidly, with resolution of heart block within days.
Lyme disease was later confirmed through serologic testing.
Why Lyme Myocarditis Can Be Missed
Lyme myocarditis can be difficult to recognize because symptoms may overlap with other conditions.
Patients—especially children and adolescents—may present with:
- Chest pain
- Shortness of breath
- Abdominal or gastrointestinal discomfort
- Fatigue or dizziness
These symptoms may initially be attributed to gastrointestinal, musculoskeletal, or cardiac causes unrelated to infection.
Can Lyme Carditis Kill You?
In rare cases, untreated Lyme carditis can be life-threatening. Early diagnosis and treatment greatly reduce this risk.
Clinical Takeaway
Lyme disease can present in unexpected ways—including symptoms that mimic gallbladder disease or primary cardiac conditions.
Early recognition of Lyme carditis is critical, particularly in patients with unexplained chest pain or abnormal cardiac findings.
Clinicians should consider Lyme disease in the differential diagnosis and obtain appropriate testing, including EKG evaluation when cardiac symptoms are present.
Start here:
Lyme symptoms guide |
Why Lyme tests can be negative |
Coinfections overview
References
- Centers for Disease Control and Prevention. Three sudden cardiac deaths associated with Lyme carditis – United States. MMWR. 2013.
- Fishe JN, Marchese RF, Callahan JM. Lyme Myocarditis Presenting as Chest Pain in an Adolescent Girl. Pediatr Emerg Care. 2016.
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
Hello Dr Cameron: my son has similar Lyme carditis symptoms now: 1st degree AV block and shortness of breath (since May), new intermittent pain in sternum (esp. upon sneezing) and abdominal pain within the last two days. He has a WB from May; pos IGm for 2 bands and IGg pos for three bands specific to Lyme per Horowitz criteria. Negative ELISA. Neg. Babesia PCR via Sonoma.
Based upon migrating muscle and joint pain, heart block, he was treated with oral doxy six weeks, June- July and then added 3 weeks of azithromycin and atovaquone for presumptive babesia when the dyspnea got worse. Muscle and joint pain resolved after 5 weeks; dyspnea improved much, as of mid July, but still remains now and is getting worse along with new onset chest and stomach pain.
His Aug 8 EKG follow-up shows 1st degree AV block still.
What imaging and testing do you recommend for him now? It seems IV ceftriaxone is far superior to oral doxy in cases like this?
Lyme disease can lead to autonomic changes that affect the stomach. C. difficile can also affect the stomach. It is hard to know if the heart block will change. I like IV. I also like doxycycline.
Hello Dr. Cameron. I an a Registered Nurse for nearly 25 years. I have a friend whose son (@35 y/o male) who is suffering from unsuccessful treatment of Lymes Disease. He, today is c/o sub- sternal pain, headaches, extreme fatigue. He lives in Maryland where he believes he was bitten by a tick. To date, he has been unable to locate a Physician who can/will treat him. He has been dealing with this for @ 2 1/2 years and I, in my Nursingexperience, believe his medicalstatus is worsening. Is there anything you can direct him towards in terms of “next steps.” I, as an RN am concerned about possible endocarditis. My email is
di**************@***il.com
My name is Diane Lee Bloodworth
I reside in Pennsylvania.
Thank you very much for any information or suggestions you may provide.
Hello Dr Cameron I’m a 43 year women I was just diagnosed with a positive western blog test for lyme disease I was given doxycycline took for 15 days only because I developed a right abdominal pain and dark urine also left side pain after this I was given 300 mg of cefdinir for a urinary tract infection ( proteus mirabilis) finish the treatment .ultrasound showed I now have one kidney inflamated and acalcoulous cholecystitis I’m having mild pain I do feel ill but nothing I cannot handle what should I do thier sending me for a HIDA scan .I’m getting intravenous ceftriaxone I believe in two days for lyme and I also have a bladder cyst and a prolapse that needs intervention any advice would be very much appreciated?
I am glad you have a doctor who is working through each of your issues. I would be concerned using IV ceftriaxone as it can leave sludge in your gall bladder and you have a history of cholecystitis. Call my office at 914 666 4665 if you have any questions.