Lyme Carditis Heart Failure: A Rare Presentation Without Ischemic Disease

A 52-year-old woman from Pennsylvania developed symptoms over a two-week period that included
shortness of breath, fever, chills, fatigue, and joint pain with stiffness. She also reported
dizziness and intermittent pre-syncope, described as near-fainting episodes.

“Echocardiography demonstrated new-onset mildly depressed left ventricular systolic
dysfunction,” the authors report. “Interestingly, coronary CTA revealed coronary arteries
with no evidence of stenosis or plaque.”

The patient did not recall a tick bite or erythema migrans rash. However, she noted that her
dog had been diagnosed with Lyme disease following a deer tick infestation several months
earlier,

the authors state.

Initial Evaluation and Treatment

The patient was initially treated for presumed pneumonia with ceftriaxone and doxycycline.
She also received intravenous furosemide for an acute heart failure exacerbation.

According to the authors, the patient’s prior electrocardiograms and echocardiograms had
been normal.

Lyme disease testing was ordered “due to the unclear etiology of new heart failure and in the
setting of this persistent bradycardia.”

Diagnosis of Lyme Carditis

The woman was ultimately diagnosed with Lyme carditis heart failure after
serologic testing revealed both IgM and IgG antibodies consistent with Lyme disease.

Her symptoms resolved completely following treatment with intravenous ceftriaxone.

Why This Case Matters

This case underscores the need for heightened clinical suspicion of Lyme carditis year-round,
particularly in regions with a high prevalence of Lyme disease.

The authors highlight two key clinical takeaways:

• Traditionally, Lyme carditis is characterized by atrioventricular block and conduction
  abnormalities. In this case, however, the patient presented with decompensated heart
  failure symptoms despite having a previously normal ejection fraction.
• While Lyme disease is most commonly acquired during the summer months due to increased
  tick exposure, the cardiac manifestations of Lyme disease may present outside this
  seasonal window.

This case expands the clinical spectrum of Lyme carditis and reinforces the importance of
considering tick-borne illness in patients with unexplained cardiac dysfunction, even in
the absence of ischemic heart disease.