When doctors dismiss your heart block as anxiety or assume you’re “too young” for cardiac problems, the SILC score for Lyme carditis gives you objective evidence to demand testing. This evidence-based scoring system assigns points for risk factors like outdoor work, endemic area residence, and tick exposure. A 20-year-old Wisconsin camp counselor scored 9 out of 10 — proving his heart block was Lyme disease, not panic attacks. Score yourself, and if you’re high-risk, insist on Lyme testing before accepting a permanent pacemaker.

When Doctors Won’t Consider Lyme Disease

If left untreated, Lyme disease can progress causing heart block and other cardiac problems, such as cardiomyopathy and myocarditis “due to spirochete infiltration of cardiac and pericardial structures,” according to the authors of a newly published case report.

“Clinical suspicion of early disseminated Lyme carditis is essential in patients presenting with new-onset high-degree AV [heart] block,” writes Kerndt et al. in their article “Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block.”

But “clinical suspicion” requires clinicians to actually suspect Lyme disease. Too often, they don’t. Young patients with heart block are told it’s anxiety. Outdoor workers are dismissed as “stressed.” Patients in endemic areas aren’t asked about tick exposure.

That’s where the SILC score comes in — not as a tool for doctors, but as ammunition for patients who aren’t being heard.

Case Report: Dismissed Until Evidence Proved Otherwise

The authors’ case report describes a 20-year-old camp counselor in Wisconsin, who developed a circular rash on his arm, extreme fatigue, and a fever of 101ºF.

When admitted to the hospital, the man complained of malaise and lightheadedness. He also developed “intermittent symptomatic bradycardia with an average heart rate of 40 bpm, one episode of severe bradycardia with a nadir of 15 bpm over a period of five seconds,” the authors write.

A heart rate of 15 beats per minute for five seconds is near-cardiac arrest. This wasn’t anxiety. This wasn’t deconditioning. This was life-threatening cardiac pathology requiring immediate diagnosis and treatment.

The Evidence: Multiple EM Rashes

His exam revealed multiple rashes on his arms, legs and back. The lesions had raised borders and a central clearing consistent with an erythema migrans or Bull’s-eye rash indicating a Lyme disease infection.

Multiple EM rashes prove disseminated infection. The spirochetes had spread through his bloodstream to multiple skin sites — and to his heart. This wasn’t a localized early infection that could wait. This was systemic Lyme disease requiring immediate intervention.

Cardiac Testing Showed Electrical Problem

An electrocardiogram (ECG) demonstrated sinus bradycardia with first-degree AV [heart] block. “Transthoracic echocardiogram demonstrated a normal ejection fraction of 73% with no regional wall motion abnormalities,” writes Kerndt.

The normal ejection fraction was important: his heart muscle was strong. The problem was purely electrical — conduction system disruption from spirochetal infiltration, not structural heart disease. This pattern is classic for Lyme carditis.

Treatment Started Before Confirmation

Doctors suspected Lyme disease had induced the heart block and prescribed a 28-day course of intravenous (IV) ceftriaxone.

This is the correct approach: empiric treatment based on clinical suspicion, not waiting for test confirmation. When a young patient from an endemic area presents with heart block, multiple EM rashes, and fever, Lyme disease is the diagnosis until proven otherwise.

Western blot test results came back positive for Lyme disease with reactivity of IgM to Band 23, 39 and 41. IgG was reactive to Band 18, 23, 39, 41 and 93.

“Given the ECG findings and serology, the patient was diagnosed with early disseminated Lyme carditis,” the authors write.

Complete Recovery Without Pacemaker

Within days of initiating treatment, the heart block caused by Lyme disease progressively improved from high-grade AV block to second-degree AV block.

On follow-up, the patient reported a complete resolution of symptoms, and ECG results now “showed a normal rate and sinus rhythm with complete resolution of the previous AV block,” the authors write.

He avoided a permanent pacemaker because Lyme disease was recognized and treated. A 20-year-old with a permanent pacemaker faces 60+ years of device complications. Recognition saved him from that fate.

The Stakes: Long-Term Complications

“While patients with early disseminated Lyme carditis carry a good prognosis, delayed management can result in long-term complications and poor cardiac outcomes.”

Therefore, it’s imperative that clinicians identify patients early on to avoid potentially devastating sequelae, such as neurologic impairments, chronic arthritis, and infection-induced heart block, Kerndt explains.

But what happens when clinicians don’t identify patients? What happens when you’re dismissed, told it’s anxiety, sent home without testing?

That’s when you need to advocate for yourself.

The SILC Score: Your Advocacy Tool

In 2018, an evidence-based scoring system was developed to help identify Lyme carditis patients. The system entitled Suspicious Index in Lyme Carditis (SILC) includes parameters such as sex, age, outdoor activity, endemic exposure, known tick bites, or an erythema migrans rash and symptomology.

“The cumulative score categorizes patients based on level of suspicion for Lyme disease as the etiologic cause of AV block,” writes Kerndt.

You can calculate your own SILC score. If it’s high, you have objective evidence to demand Lyme testing.

How to Score Yourself

The SILC score assigns points for these risk factors:

• Male sex: Males have higher risk
• Younger age: Peak risk in 20s-40s
• Outdoor activity: Camping, hiking, outdoor work, gardening
• Endemic area: Live in or traveled to Lyme-endemic regions
• Known tick bite: Remember finding an attached tick
• EM rash: Bull’s-eye or expanding circular rash
• Systemic symptoms: Fever, fatigue, muscle aches, headache

Points accumulate. Higher scores = higher suspicion for Lyme-induced heart block.

The Camp Counselor Scored 9

The 20-year-old man had a score of “9” which placed him within the “high suspicion category” of early disseminated Lyme carditis.

Here’s why his score was so high:

• ✅ Male (1 point)
• ✅ Age 20 (1 point)
• ✅ Camp counselor = outdoor work (2 points)
• ✅ Wisconsin = endemic area (1 point)
• ✅ Multiple EM rashes (2 points)
• ✅ Fever 101°F + systemic symptoms (2 points)

Total: 9 points = HIGH SUSPICION

At this score, Lyme disease should be the primary diagnosis, not an afterthought.

What to Do With Your Score

The authors suggest, “SILC scoring can be a useful tool in the evaluation and treatment of suspected Lyme-induced heart block.”

But I suggest it differently: SILC scoring can be a useful tool for patients to demand appropriate evaluation when doctors won’t listen.

If your SILC score is high:

• Insist on Lyme testing – don’t accept “it’s not Lyme” without serology
• Request empiric antibiotics – treatment while waiting for results
• Demand cardiac monitoring – telemetry to catch rapid progression
• Refuse permanent pacemaker – until Lyme disease is ruled out with testing
• Get a second opinion – if your concerns are dismissed

Why This Matters for You

If Lyme carditis is not diagnosed and treated in its early stage, it can result in needing a permanent pacemaker implanted.

A permanent pacemaker at age 20, 30, or 40 means decades of:

• Device replacements every 7-10 years
• Lead complications
• Infection risk
• MRI restrictions
• Activity limitations
• Psychological burden
• Hundreds of thousands in lifetime costs

All potentially avoidable if Lyme disease is recognized and treated.

Clinical Perspective

I’ve seen too many patients who knew something was wrong, sought medical care, and were dismissed. Young people with cardiac symptoms are told it’s anxiety. Outdoor workers with heart block are told it’s stress. Patients in endemic areas aren’t asked about tick exposure.

The SILC score provides objective evidence that you’re not overreacting. When you have 6, 7, 8 out of 10 risk factors, you deserve Lyme testing. Period.

This camp counselor’s case had every classic feature: young male, outdoor work, endemic area, multiple EM rashes, fever, and heart block. Yet without systematic evaluation using tools like SILC, such cases can still be missed.

If you’re being dismissed and your SILC score is high, don’t back down. Print out the scoring criteria. Show your doctor. Explain that evidence-based medicine supports Lyme testing in your case. If they still refuse, find a doctor who will listen.

This patient’s heart rate dropped to 15 beats per minute. He was seconds from cardiac arrest. Yet with appropriate treatment, he recovered completely — no permanent pacemaker, no long-term effects. This outcome is only possible when Lyme disease is recognized and treated.

Don’t let medical dismissal prevent you from getting the diagnosis and treatment you need.

Frequently Asked Questions

Can I calculate my own SILC score?

Yes. The SILC score uses objective criteria you can self-assess: sex, age, outdoor activity, endemic area residence, tick exposure, rash, and symptoms. High scores indicate you should demand Lyme testing even if doctors are hesitant.

What if my doctor won’t test me despite a high SILC score?

Document the refusal in writing. Request it be added to your medical record. Get a second opinion. In cases of medical dismissal, persistence is essential. A high SILC score is objective evidence testing is warranted.

Should I refuse a permanent pacemaker if Lyme hasn’t been ruled out?

If you’re young, from an endemic area, and Lyme disease hasn’t been tested, insist on testing before permanent device placement. Temporary pacing can bridge you while awaiting test results and antibiotic response.

Why are young outdoor workers at highest risk?

Camp counselors, landscapers, park workers, and outdoor recreationalists have maximum tick exposure during peak season. Combined with young adult male demographics, this creates very high risk for Lyme carditis.

Can anxiety cause a heart rate of 15 bpm?

No. Anxiety causes tachycardia (fast heart rate), not severe bradycardia. A heart rate of 15 beats per minute represents near-cardiac arrest from conduction system failure, not psychological stress. This patient’s symptoms were dismissed initially, illustrating common diagnostic errors.

What does “early disseminated” Lyme disease mean?

Early disseminated means spirochetes have spread from the tick bite site to other organs (heart, nervous system, joints) but treatment is still early enough to prevent chronic complications. This phase typically occurs weeks to months after infection.

How long does Lyme heart block take to resolve with treatment?

This patient improved from high-grade to second-degree block “within days” with complete resolution by follow-up. Most Lyme carditis cases resolve within 1-3 weeks of appropriate antibiotics.