Lyme Disease Heart Palpitations
Heart palpitations may occur with Lyme carditis
Normal cardiac MRI may not exclude rhythm problems
Early recognition can reduce cardiac complications
Lyme disease heart palpitations can occur when Lyme carditis affects the heart’s electrical system. Patients may describe an uneasy feeling in the chest, skipped beats, slow heart rate, exercise-related symptoms, or fatigue.
Some patients with tick-borne illness also report tachycardia, dizziness, exercise intolerance, or temperature dysregulation, which may overlap with autonomic dysfunction.
Although Lyme carditis most often presents with atrioventricular block, other rhythm problems can occur. This case highlights sinoatrial dysfunction after recent oral antibiotic treatment for Lyme disease.
The case involved a 46-year-old man with Lyme disease who presented to the clinic with cardiac complications, which initially manifested as palpitations.
The patient lived in a Lyme-endemic region and reported that one month earlier, he had a “pinching sensation in his right thigh with an associated macular erythematous rash,” according to the authors. He did not notice a tick bite.
The man later developed high fevers, fatigue, and a second rash on the upper left part of his body.
Lyme disease testing was positive for IgG and IgM titers.
“He had initially started cephalexin at home and was subsequently prescribed a 2-week course of doxycycline,” the authors state.
Can Lyme disease cause heart palpitations after treatment?
“During the second week of his antibiotic therapy, he noted palpitations and an uneasy feeling in his chest that occurred following exercise.”
After 13 days of doxycycline for Lyme disease treatment, the patient experienced cardiac complications, including palpitations and fatigue.
He was admitted for evaluation, where cardiac MRI was performed. Findings were normal.
However, a mobile electrocardiogram (ECG) detected “sinus pauses with periods of both wide and narrow complex escape rhythm,” the authors state.
Lyme carditis and rhythm abnormalities
“Lyme carditis is a potential cause of sinoatrial dysfunction and may occur in patients who have recently been treated with oral antibiotics.”
Further testing revealed sinus bradycardia, meaning a slower-than-normal heart rate. The patient was treated with intravenous ceftriaxone.
According to the authors, “he was diagnosed with partially treated early disseminated Lyme disease, considered to be the etiology of his sinoatrial nodal disease.”
Patients with Lyme carditis may present with palpitations, chest discomfort, exercise intolerance, dizziness, shortness of breath, presyncope, or fatigue.
Patients with palpitations, chest discomfort, shortness of breath, syncope, or abnormal rhythm findings may require evaluation for Lyme carditis, particularly in Lyme-endemic regions.
Can Lyme disease cause heart problems with a normal MRI?
“Lyme carditis manifesting as isolated sinoatrial dysfunction might not result in detectable abnormalities on cardiac magnetic resonance imaging [MRI].”
This case illustrates that a normal cardiac MRI may not exclude Lyme-related rhythm abnormalities. Remote or mobile cardiac monitoring may identify intermittent abnormalities that are missed during routine evaluation.
Intermittent rhythm disturbances may require ECG, Holter monitoring, mobile monitoring, or cardiology evaluation when symptoms persist.
The patient’s cardiac complications resolved after appropriate treatment with IV ceftriaxone.
This case highlights how rhythm abnormalities may emerge despite early treatment and why clinicians should maintain suspicion when symptoms persist.
Authors’ takeaways
- “Although Lyme carditis most commonly manifests as atrioventricular nodal block, all cardiac tissues are susceptible to spirochete invasion.”
- While cardiac MRI can assist with diagnosing Lyme carditis, this patient’s MRI results were normal.
- The onset of cardiac complications associated with sinus dysfunction occurred after the patient had received 1 week of antibiotic treatment for Lyme disease. Therefore, “a recent history of oral antibiotics should not be a deterrent to considering a Lyme carditis diagnosis when clinically appropriate.”
- “Appropriate diagnosis and treatment of Lyme carditis may be instrumental for reducing the risk of unnecessary cardiac implantable electronic device placement…”
- Patients who may be at risk for Lyme disease and who exhibit cardiac complications despite normal ECG findings may benefit from remote cardiac monitoring. In this case, sinus dysfunction was identified with a mobile device.
Frequently Asked Questions
Can Lyme disease cause heart palpitations?
Yes. Lyme carditis can affect the heart’s electrical system and may cause palpitations, skipped beats, slow heart rate, dizziness, chest discomfort, or fatigue.
Can Lyme disease cause bradycardia or a slow heart rate?
Yes. Lyme carditis may cause conduction abnormalities or sinus bradycardia, which can lead to a slower-than-normal heart rate.
Can Lyme carditis occur after antibiotics?
Yes. This case illustrates that cardiac complications may still be considered even after recent oral antibiotic treatment when symptoms and rhythm findings suggest Lyme carditis.
Can a cardiac MRI be normal with Lyme carditis?
Yes. Lyme-related rhythm abnormalities may occur even when cardiac MRI does not show detectable abnormalities.
Can Lyme disease cause a racing heart?
Some patients report tachycardia or a racing heart. Lyme carditis, autonomic dysfunction, fever, inflammation, or other cardiac causes may need evaluation.
When should heart palpitations raise concern for Lyme carditis?
Heart palpitations may warrant evaluation when they occur with chest discomfort, shortness of breath, dizziness, syncope, slow heart rate, heart block, recent rash, or possible tick exposure.
Clinical Takeaway
Lyme disease can cause heart palpitations and other rhythm abnormalities when Lyme carditis affects the heart’s electrical system.
A normal cardiac MRI or recent oral antibiotic treatment should not automatically exclude Lyme carditis when palpitations, bradycardia, sinus pauses, or other cardiac findings persist.
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References
- Chen B, Krumerman A. Lyme carditis–induced sinoatrial dysfunction after initiation of targeted oral antibiotic therapy: A case report. HeartRhythm Case Reports. 2023.
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
I am curious if a Lyme carditis patient that still exhibits an asymptomatic first degree right bundle branch block years after IV Rocephin treatment has any increased risk of cardiac events? Does the continued presentation of RBBB indicate continued presence of infection despite resolution of acute illness reflected by normalization of IgM antibodies confirmed by highly sensitive Western blot?
I got bit by 3 different ticks within 24 hours. A couple of days later I started running a low grade fever. 100.1 and my back pain was unbearable. 3 months later still running 99.6 temp every day.My heart rate was 151. Put me on a beta blocker then doubled it when it went back up to 127. Will it ever go back down to normal?
A persistent elevated heart rate after tick bites deserves a careful evaluation for an underlying cause. In my practice, I also consider autonomic dysfunction as part of the evaluation, particularly when patients develop symptoms such as tachycardia, temperature dysregulation, dizziness, fatigue, or exercise intolerance following a tick-borne illness.