Lyme Carditis Causes Third-Degree Heart Block in Teen
Lyme carditis can affect heart rhythm
A teenager developed third-degree heart block
Prompt treatment led to recovery
This case highlights how Lyme carditis can present with life-threatening cardiac conduction abnormalities, including third-degree heart block and ventricular tachycardia.
Medics found the boy to be pale, with a heart rate of 300 beats per minute and unstable regular wide complex tachyarrhythmia (WCT). He was given a dose of amiodarone but remained in ventricular tachycardia.
At the hospital his blood pressure dropped to 66/30 mm Hg and his dizziness and shortness of breath worsened. “After a trial of anti-arrhythmic medication, his clinical condition declined, necessitating synchronized cardioversion,” writes Nawrocki.
Lyme Carditis and Third-Degree Heart Block
After stabilizing the patient, he was transferred to a cardiac intensive care unit (ICU) at a children’s hospital, where he was diagnosed with third-degree heart block after ventricular tachycardia.
Doctors suspected Lyme disease and prescribed an empiric course of intravenous ceftriaxone 2 grams once daily. The diagnosis was later confirmed by Western blot testing.
[bctt tweet=”Lyme disease causes complete heart block in 15-year-old boy.” username=”DrDanielCameron”]
“Because of ongoing bradycardia and hypotension, he underwent placement of a transvenous pacemaker for rate control,” writes Nawrocki.
Can Lyme Carditis Cause Ventricular Tachycardia?
Three additional episodes of ventricular tachycardia occurred during the hospitalization, two requiring cardioversion.
Although Lyme carditis is more commonly associated with atrioventricular conduction abnormalities and heart block, this case demonstrates that serious arrhythmias can occur in some patients.
How Is Lyme Carditis Treated?
Patients with suspected Lyme carditis may require hospitalization, cardiac monitoring, intravenous antibiotics, and temporary pacing depending on the severity of the conduction abnormality.
In this case, the patient required intravenous ceftriaxone, cardioversion, and temporary transvenous pacing before the heart block resolved.
After several days of intravenous antibiotics, the boy’s heart block gradually resolved and the pacemaker was removed.
Can Third-Degree Heart Block From Lyme Disease Be Reversible?
This case demonstrates that Lyme carditis-associated heart block may improve with appropriate treatment.
The patient was discharged on day 12 and “was reportedly doing well at the 1-year follow-up without any sequelae of his acute illness,” writes Nawrocki.
Unlike some other causes of complete heart block, Lyme carditis may be reversible when recognized and treated promptly.
Lyme Carditis in Children and Teenagers
Although Lyme carditis is uncommon, it should be considered in children and adolescents from endemic regions who present with unexplained arrhythmias, heart block, dizziness, shortness of breath, syncope, or palpitations.
Clinicians should maintain a high index of suspicion when evaluating young patients with new cardiac conduction abnormalities, particularly during tick season.
“Our case report describes the successful and appropriate hospital management of a patient with advanced Lyme disease causing cardiac conduction abnormalities,” the authors write.
Frequently Asked Questions
Can Lyme disease cause third-degree heart block?
Yes. Lyme carditis can disrupt the electrical conduction system of the heart and may lead to third-degree heart block.
Can Lyme carditis cause ventricular tachycardia?
Although uncommon, this case demonstrates that ventricular tachycardia can occur in patients with Lyme carditis.
Can Lyme carditis be reversed?
Many patients improve with prompt antibiotic treatment, and conduction abnormalities may resolve over time.
What are the symptoms of Lyme carditis?
Symptoms may include palpitations, dizziness, shortness of breath, chest discomfort, fainting, bradycardia, or other heart rhythm abnormalities.
Clinical Takeaway
Lyme carditis can present with serious cardiac conduction abnormalities, including third-degree heart block and, in rare cases, ventricular tachycardia.
This case highlights the importance of recognizing Lyme carditis promptly, as appropriate treatment may lead to reversal of heart block and an excellent long-term outcome.
Related Articles
12-year-old boy suffers cardiac arrest due to Lyme disease
5 things to know about Lyme carditis
When Lyme disease mimics a heart attack
Lyme carditis causes complete heart block in 26-year-old man
References
- Nawrocki PS, Poremba M. A 15-Year-Old Male With Wide Complex Tachyarrhythmia. Air Med J. 2018;37(6):383-387.
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
