Lyme carditis and heart failure

In their article “Lyme Carditis: A Rare Case of Heart Failure in the Absence of Ischemic Heart Disease,” Mensah and colleagues describe a patient with atypical symptoms of Lyme carditis, which included new-onset heart failure (despite no history of ischemic heart disease) and uncommon EKG changes. [1]

The 52-year-old woman from Pennsylvania developed shortness of breath, fever, chills, fatigue, and joint pain and stiffness over a 2-week period. She also reported dizziness and occasional pre-syncope (feelings of fainting).

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

The woman did not recall a tick bite or rash but she “mentioned her dog’s diagnosis of Lyme disease following deer tick infestation a few months prior,” the authors state.

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

She was initially treated for presumed pneumonia with ceftriaxone and doxycycline, along with intravenous furosemide therapy for acute heart failure exacerbation.

According to the authors, the patient’s prior EKGs and echocardiograms were normal.

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

The woman was diagnosed with Lyme carditis after Lyme disease tests were positive, with IgM and IgG antibodies present.

Her symptoms resolved completely following treatment with intravenous ceftriaxone.

Authors conclude:

• • Traditionally, Lyme carditis is characterized by atrioventricular block and conduction abnormalities. However, in this instance, the patient presented with decompensated heart failure symptoms despite having a previously normal ejection fraction.
  • While Lyme disease is predominantly contracted during the summer months due to heightened outdoor activities and increased tick exposure, the development of Lyme carditis can extend beyond this seasonal pattern.