Lyme Carditis Heart Block in a Young Man: A Case Report
Lyme carditis heart block can occur even in otherwise healthy young adults. In some cases, the first sign of Lyme disease is a disturbance in the heart’s electrical system that slows the heartbeat dangerously.
When doctors dismiss symptoms as anxiety or assume someone is “too young” for heart problems, an evidence-based tool called the Suspicious Index in Lyme Carditis (SILC) score can help identify patients at risk. The scoring system assigns points for factors such as outdoor activity, residence in a Lyme-endemic area, tick exposure, and erythema migrans rash.
In one published case, a 20-year-old Wisconsin camp counselor with heart block scored 9 out of 10 on the SILC scale — supporting Lyme carditis as the cause rather than panic or stress.
Although Lyme carditis is considered rare, occurring in roughly 1% of reported Lyme disease cases, the condition can progress rapidly when it occurs and may lead physicians to consider temporary or permanent pacemakers if the infection is not recognized.
When Doctors Fail to Consider Lyme Carditis
If untreated, Lyme disease can progress and involve the heart. This condition, known as Lyme carditis, can lead to conduction abnormalities including atrioventricular (AV) block, myocarditis, and cardiomyopathy due to spirochete infiltration of cardiac and pericardial tissues.
“Clinical suspicion of early disseminated Lyme carditis is essential in patients presenting with new-onset high-degree AV block,” write Kerndt and colleagues in their article Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block.
However, recognizing Lyme carditis requires clinicians to actually consider Lyme disease in the differential diagnosis—something that does not always occur. Young patients with heart block may be told their symptoms are anxiety or stress, while clinicians overlook possible tick exposure in endemic regions.
Structured tools such as the SILC score can help clinicians identify patients whose heart block may be related to Lyme disease.
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
Hi Dr.Cameron- I wAs a patient of yours bk in 2008-12. I was diagnosed late stage.
You worked with me bk Forth from saratoga to mt kisco. You did start my journey bk to life’. Took a few years, with your help- 75% of The fatigue, heart issue, Neuropathy, joints, sensory overload, etc… did seem to disappear. I can have severe moments of brain fog, short term memory. I did see a neuropthamologist bk then. My eyes did play tricks. This did subside. But- did seem to come & go. Over the years I wrote it off as normal aging. Until this past year- my vision does change often. Blurry, far sighted, near sighted & can randomly not see at night. Seem to be progressing too fast. With covid- I put appt off until this month. I just read your article about lyme & eye issues. Is there a certain test or tests I should ask for in regards to confirming if this is lyme related? Any insight would be appreciated. I will always be grateful for the time, & expertise You & your staff gave me. You did assist in bringing me bk to life. Thank you for never giving up on lyme & having a voice.
I am glad you improved. It is still frustrating to have continued symptoms. I do not have any specific test for your eyes that I am aware of. Call my office at 914 666 4665 if you have any questions.
Hi! I read this as a person diagnosed a couple of years ago with a first degree heart block. Previously, I was treated with a PICC line and penicillin pump for a 28 day cycle for Neuro Lyme. That original Lyme had gone untreated for at least 10 years as my GP poo-poo’d Lyme results and ignored my complaints.
I have borderline deafness that no one can explain, and this first degree heart block. I’m suspicious that both may be from the Lyme infection.
As for the heart block, I was given a stress test, monitored for a month, told it’s normal for bp to get down to 30 on occasion (I am NOT an athlete) and sent home.
I’m feeling a bit nervous, and wondering if this could all be down to the Lyme, and what else could be lying in wait for me. I’m 53 and was diagnosed with the Neuro Lyme in 2016, 1st degree heart block found in 2020.
I always advise my patients to again include a doctor experienced in treating Lyme disease. Some of them have cardiac and Lyme disease issues as both are common.
Interesting article and important issue. It is particularly important that the authors remark that treatment was started because of the ‘suspicion’ of Lyme carditis. Waiting for confirmatory lab testing, especially if the testing is negative or equivocal, can be disastrous. Also glad that they investigated for cardiac dysfunction in addition to the heartblock. Although perhaps not the most common manifestation of heart involvement in Lyme it does occur. They talk about the specificity of serology, but omit discussion of the sensitivity. I would hope that they would have continued ceftriaxone based on clinical presentation and course while they evaluated for other etiologies, though their writing suggests that would not be the expected course of action; perhaps an important take away thought. The SILC scoring can indeed be useful as a way of codifying a useful and practical approach one might use regardless of familiarity with Lyme disease and its manifestations! Thanks for this interesting post. And for all you do all the time!