Lyme disease infection triggers heart block in young man
Although Lyme carditis is reportedly an infrequent manifestation of Lyme disease, new-onset heart block in young patients is exceptionally rare. And a lack of objective Lyme disease symptoms, such as an erythema migrans rash, can make it challenging to diagnose Lyme carditis in this patient population. But a new tool, developed in 2018, may assist clinicians in identifying possible cases.
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.¹
“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.”
20-year-old camp counselor develops heart block
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.
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.
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.
Doctors suspected Lyme disease had induced the heart block and prescribed a 28-day course of intravenous (IV) ceftriaxone.
READ MORE: How Lyme myocarditis might present in an adolescent patient
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.
Early diagnosis prevents long-term complications
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.It's critical for clinicians to recognize and treat Lyme carditis early to avoid long-term cardiac complications. Click To Tweet
“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.
Scoring system helps identify Lyme-induced heart block
If Lyme carditis is not diagnosed and treated in its early stage, it can result in the patient needing a permanent pacemaker implanted.
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.
The 20-year-old man had a score of “9” which placed him within the “high suspicion category” of early disseminated Lyme carditis.
The authors suggest, “SILC scoring can be a useful tool in the evaluation and treatment of suspected Lyme-induced heart block.”
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First case of reversible complete heart block due to Lyme disease reported in Canada
Lyme disease induces severe cardiac problems in 15-year-old boy
- Kerndt C. Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block. Case Reports in Cardiology, Volume 2020, Article ID 5309285, https://doi.org/10.1155/2020/5309285.
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!
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.
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.