Lyme Carditis Diagnosis: ECG Findings in 18 Cases
Lyme carditis may cause fluctuating ECG abnormalities
AV block, bradycardia, and arrhythmias may occur early in infection
Prompt recognition may help prevent serious cardiac complications
Lyme carditis is a potentially serious complication of Lyme disease involving inflammation of the heart tissue and cardiac conduction system.
“[Lyme carditis] is caused by direct invasion of myocardial tissue by spirochetes and an immunological host response causing lymphocyte inflammation,” Marcos and colleagues explain in their discussion of Lyme carditis diagnosis.
The authors add that B. burgdorferi has a tendency to involve the atrioventricular (AV) node, leading to variable conduction abnormalities.
Learn more about Lyme carditis symptoms and complications.
Study evaluated 18 Lyme carditis cases
The 18 patients with possible Lyme carditis were predominantly Caucasian males with a mean age of 44.5 years, ranging from 24 to 79 years old.
All patients met the CDC surveillance case definition for Lyme disease.
One patient had an erythema migrans rash despite negative blood tests. The remaining patients demonstrated Lyme-specific antibody bands consistent with infection.
Common symptoms at presentation
The most common symptoms included:
- Chest tightness
- Dizziness
- Shortness of breath with exertion
- Exercise intolerance
- Lightheadedness
Symptoms had reportedly been present from 4 to 30 days before evaluation.
Lyme carditis ECG findings
The patients exhibited a broad range of ECG abnormalities.
The authors reported:
- Second- and first-degree AV block
- Right bundle branch block (RBBB)
- Atrial fibrillation
- T-wave inversion
- Sinus bradycardia with ST elevation
- Prolonged QT interval
The authors also identified broader cardiac manifestations in previously published literature, including:
- Left bundle branch block (LBBB)
- AV dissociation
- Widened QRS complexes
- Ventricular dysfunction
- Fulminant myocarditis
- Cardiac arrest
See also Lyme carditis causing complete heart block.
ECG abnormalities may fluctuate rapidly
One important feature of Lyme carditis is that conduction abnormalities may fluctuate quickly.
A patient may initially present with mild conduction delay and rapidly progress to higher-degree AV block.
This variability may complicate diagnosis, particularly when Lyme disease is not initially suspected.
Early recognition is especially important in endemic areas during tick season.
Lyme carditis may mimic other cardiac conditions
Lyme carditis may resemble viral myocarditis, idiopathic conduction disease, or other arrhythmias.
Some patients may undergo extensive cardiac evaluations before Lyme disease is considered.
Delayed diagnosis may increase the risk of severe conduction abnormalities or unnecessary procedures.
Read more about Lyme disease misdiagnosis.
Diagnosis may require clinical suspicion
Lyme carditis diagnosis is based on a combination of clinical history, symptoms, ECG findings, exposure risk, and laboratory testing.
Blood tests may occasionally be negative early in infection, especially in patients presenting soon after symptom onset.
The presence of dizziness, chest symptoms, syncope, or fluctuating AV block in someone with possible tick exposure should raise concern for Lyme carditis.
Frequently Asked Questions
What is Lyme carditis?
Lyme carditis is a cardiac complication of Lyme disease in which the infection affects the heart tissue or electrical conduction system.
Can Lyme disease cause ECG abnormalities?
Yes. Lyme disease may cause AV block, bundle branch block, bradycardia, atrial fibrillation, and other ECG abnormalities.
What symptoms are common in Lyme carditis?
Chest tightness, dizziness, palpitations, fainting, shortness of breath, and exercise intolerance are commonly reported symptoms.
Can Lyme carditis come and go?
Yes. Conduction abnormalities in Lyme carditis may fluctuate rapidly over hours or days.
Can Lyme carditis be treated?
Many patients improve with prompt antibiotic treatment and cardiac monitoring, although severe cases may require hospitalization.
Clinical Takeaway
Lyme carditis may present with a surprisingly broad range of ECG abnormalities, including AV block, bundle branch block, atrial fibrillation, bradycardia, and myocarditis.
Because cardiac conduction abnormalities may fluctuate rapidly, clinicians should maintain suspicion for Lyme carditis in patients with compatible symptoms and possible tick exposure.
Early recognition and treatment of Lyme carditis may help prevent life-threatening cardiac complications.
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References
- Marcos LA, Castle PM, Smith K, Khoo T, Morley EJ, Bloom M, Fries BC. Risk factors for Lyme carditis: A case-control study. Eur J Prev Cardiol. 2019.
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
Thank you for this important perspective. Dr. Cameron have you seen complex erratic blood pressures, with orthostatic hypertension, in your Lyme patients? It seems important to define such situations as having a neurological or cardiac basis ?
The problem is related in part to the effect of tick-borne illnesses on the autonomic nervous system. The issues are complex. There are POTS professionals that have described the complexity of these presentions. I find the problem is common in my patients.
Any information for connection between long-standing Lyme disease and extensive Aortic dissection.
I have read somewhere of Lyme interfering with collagen synthesis.
I was in the hospital a year ago. One doctor said he thought is was Lyme carditis. the cardiologist rolled his eyes at me and referred me to an elecrophysiologist. The diltiazem had my blood pressure @ 35/53 and terrible shortness of breath. I took myself off of it. He is located at Beth Israel. He wants to do a pulse field ablation for AFib. I was diagnosed with Lyme in 2020. Had your typical 3 weeks of doxy. My dentist puts me on doxy for his procedures. A small cut will lead to cellulitis. One cut on ankle and I had to go to a wound specialist. Back on doxy. I am 79 years old and I am scared to have the ablation. Infection and general anethesia frightens me. I saw what can happen with my mother and mother-in-law. I am of sound mind now and would hate to lose that. If I get an internal infection I’m doomed if no one notices it. Will this be dangerous for me? I get no explanations from anyone. My primary died in 2019 and I’ve had poor care since. Could I have a bit of advice?
Thank you for sharing this—your concerns are very understandable, especially given your past experiences and not getting clear answers.
I can’t provide individual medical advice here, but with complex issues like atrial fibrillation, possible Lyme involvement, and side effects from medications like diltiazem, it’s reasonable to ask for a clear explanation of risks and options—or seek a second opinion.
Your concerns about safety, infection, and quality of life deserve to be taken seriously.