When Lyme disease mimics a heart attack

Lyme disease has earned a reputation as the great imitator, because its symptoms can mimic many other illnesses. In a case report, presented by Gilson and colleagues from Easton Hospital in Pennsylvania, a 45-year-old woman was believed to be suffering from a heart attack when, in fact, her symptoms were due to Lyme disease. [1]

According to the authors, Lyme disease mimicked a myocardial infarction (heart attack)  in a 45-year-old woman who presented with a sudden onset of chest pain, radiating to her neck. The evidence supporting a diagnosis of myocardial infarction was strong. A medical workup showed the woman had EKG changes, high admission levels of Troponin and CK-MB, and rising Troponin and CK-MB at 6 hours. Fortunately, the woman’s cardiac catheterization did not show any significant obstructive coronary artery disease.

She was diagnosed with Lyme disease 2 days later after she had developed a right-sided facial palsy. The diagnosis was confirmed by ELISA and positive IgM and IgG antibodies.

Treatment was successful with a combination of intravenous ceftriaxone and oral steroids.

“This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities,” writes Gilson.

[bctt tweet=”Lyme disease mimics heart attack.” username=”DrDanielCameron”]

The authors point out the difficulties diagnosing atypical manifestations of Lyme disease, stating, “Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers.”

The authors reminded doctors of the need to include Lyme disease in the differential diagnosis even in patients presenting with clinical symptoms suggestive of acute coronary syndrome.

Related Articles:

Lyme carditis causes complete heart block in 26-year-old man

12-year-old boy suffers cardiac arrest due to Lyme disease

What might sudden cardiac death due to Lyme disease look like?


  1. Gilson J, Khalighi K, Elmi F, Krishnamurthy M, Talebian A, Toor RS. Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction. J Community Hosp Intern Med Perspect. 2017;7(6):363-365.

31 Replies to "When Lyme disease mimics a heart attack"

  • Robert Rose
    08/22/2018 (2:40 pm)

    I had a tick bite 8 months ago with a cascading rash. I started having a host of symptoms (swollen lymph nodes, left side facial insensitivity including the tongue, tingling in the arms, legs, and back of the head. I have a low body temp 97.5 and had terrible flu like symptoms. I was tested (Quest labs) using Western blot and was negative. I am an avid runner but started having minor chest pains (left side) that have progressively gotten more constant. They do not worsen with exercise. I received an MRI on brain which was negative. I have had 2 EKGs and have also had a stress test with contrast. All negative. All blood work negative. I am taking lisinopril for blood pressure and am on daay 30 of a 42 day doxy regiment. The symptoms have improved significantly with the exception of the chest pain. Any ideas?

    • Dr. Daniel Cameron
      08/22/2018 (4:13 pm)

      Thanks for sharing your story. It is very common to end up with a wide range of tests in addition to tick borne illness. It sounds as if your doctor treated you based on clinical judgemnt with modest gains. Antibiotics can lead to chest pain. You should make sure you take probiotics. It is it doxycycline, you may need to take it with food. You will need followup to check to see if you are well. Don’t forget coinfections e.g. Babesia. My comments are meant for discussion and should not be a substitute for your doctor. You will need to work with your doctor.

      • Su May
        12/09/2020 (3:24 pm)

        This post caught my eye after a month of disconcerting chest pain directly over my heart and right side arm pressure and pain, especially while taking minocycline. Was diagnosed with Lyme 13 years ago and bartonella just two months ago. Went to ER, heart and lungs are fine, blood work is good, thyroid is fine but Hashimoto’s is flaring.

        Dr. Cameron mentioned that antibiotics lead to chest pain–why is that? Is this a sign of a problem or just one more thing to get used to? So greatful for these forums, thank you!

        • Dr. Daniel Cameron
          12/09/2020 (7:20 pm)

          I have seen chest pain related to gastritis or costochondritis due to Lyme disease. I have also seen chest pain relate to heart disease. I always include a cardiologist in the mix.

    • Michael
      10/25/2019 (8:29 pm)

      Hi Robert, I was wondering if your symptoms went away? Everything sounds very similar to what I have and I am a runner too. It started as a minor chest pain (left side) and slowly spread to a pretty bad shoulder and neck pain that gets worse at nights. I feel like my muscles on the upper left side got heavy or swollen and push on my nerves and that’s causing pain. It comes along with fatigue and low body temperature. There are good days and bad days. It’s been for 6 months. Quest lab tests for lyme came negative. I did 3 MRIs and chest CT scan – all negative. Not sure what’s going on and what should be my next step. Doctors tell me it’s not lyme, but nothing really helps and everything does sound awfully similar to what other people say on this page. If all your are symptoms has gone away, I will ask my doctors to prescribe doxy too. Thanks a million for any info.

  • Christine rogers
    08/05/2018 (4:58 pm)

    I Was finally diagnosed with lymes disease after going to the er for chills ,fever neck pain in 2016 by my primary care after the erythema rash developed on my knee several days later. I was placed on doxy for 10 days and all was good. Aug 2 2018 I woke with pain in my left shoulder pain , thought I slept wrong I took some aleeve in the morning went to work and still felt the discomfort. I develvedoped chills and thought am I getting lymes again. I had aches and pain in my upper body., pain when taking deep breath also. I went home thinking should I have gone to the er again. I took aleeve again and later had chills took my temp was 100.2 . I had no appetite. I tried to lie down for a while and rest and could not get comfortable at all. The pain in my shoulder and chest when I breathed was getting worse. So at 2 am I drove myself to my local er thinking I was having a heart attack or pulmonary embolism. I was taken quickly ekg no changes my bp was 211/90 hr 90. Labs drawn . All neg except for bnp was 298. Ct for pe was neg but did show Cardiomegaly. Lyme test was neg no rashes.
    The er physician discussed I was not in any life threatening state. I stated to him it must be lymes again , my symptoms were very similar to 2016 except I had no chest pain or shoulder pain.i started on doxy that morning and chest pain and shoulder pain decreased . The pain would flare up and I would take ibproben 600mg every 12 hours and that seem to help a lot. I was able to sleep . I have access to my medical records and reviewed them from my visit in 2016 my chest X-ray showed Cardiomegaly also my crp was 3.9. . I made an appointment to see my primary care in 2 weeks . I am courious what labs should be drawn , should I see a cardiologist? I am also thinking of going to the Lyme research in Valhalla. Any suggestions.

    • Dr. Daniel Cameron
      08/05/2018 (9:15 pm)

      You should definitely see a cardiologist. You also should pursue the tick borne infection question. Doctors are divided on their approach to tick borne illnesses. You should weigh the different treatment approaches.

  • Gretchen Bryan
    03/19/2018 (10:53 pm)

    This is how my Lyme story started 3+ years ago. I had symptoms of a heart attack, raised troponin levels. All other cardio test came back that as a 50 year old, I had the cardiovascular system of a 35 year old.
    I still have some palpitations, but my chest pain and back pain have cleared for the most part. My worst symptom is daily horrendous anxiety, major depression, crying jags. Still very scary for me EVERY DAY. Still in treatment.

    • Jen
      10/07/2018 (6:02 pm)

      Hello, I have had Lyme for over over 10 years it is believed. I did a short course of abx when I found out, now am
      On herbal treatment. I had a oil set embolism before beginning the herbal treatment last year. A huge history o unexplained chest pains and tachycardia with a near normal cardiac workup other than some what my doc describes as insignificant ekg changes. They won’t even refer me to cardiology again although my symptoms are much the same and unimproved.

      • Dr. Daniel Cameron
        10/07/2018 (8:15 pm)

        Doctors differ in how they look at Lyme disease. You should seek a Lyme disease second opinion in addition to followup by a cardiologist.

  • Suzie
    02/20/2018 (1:38 pm)

    My husband was 59 when he died from Lymes Carditis. All Lymes tests for the month prior were negative. The CDC and Minnesota Department of Public Health confirmed the results after his autopsy.

    • Pam
      02/21/2018 (1:34 pm)

      Just wanted to tell you how sorry I am for the loss of your husband. Everything about this disease is horrible, including the lack of support from doctors and insurance companies, dismissal by the media and consequent ridicule from the public. So grateful to the medical professionals, researchers and patients who work tirelessly to change things for the better. Hoping you have some of those people in your life, and that those relationships provide the love and support you deserve.

    • Thalia
      07/27/2020 (8:41 pm)

      Thats makes me so sad and scared 😭 My condolences. Im 21 and was actually positive for it. I’m being treated with doxy but im still scared I can die from this. I have anxiety 🙁

      • Pamela Gutsch
        10/21/2020 (10:49 pm)

        How are you doing now? I am currently on Doxycycline It’s been interesting feeling the medication work in various body parts. I had Herxheimer reaction, which went away and am now with chest pain behind the left breast, but all other symptoms are disappearing, as I believe the cheat pain will too. Have you recovered?

  • Catherine
    02/18/2018 (3:00 am)

    PTLDS is a medical term implying that all medical treatment has failed, and that one’s only hope is to seek alternatives outside the medical system. Chronic Lyme Disease, on the other hand, is acknowledgment of a disease process that proceeds Borrelia infection and by nature of tick biology, may include multiple co-infections. Whether by ongoing infection, immune response, unknown factors or a combination of these, people are still sick and treatments still need to be explored. Please stop calling it post treatment.

    • Dr. Daniel Cameron
      02/18/2018 (8:10 am)

      I am not happy with the term either. The 2006 IDSA guideline advised using the PTLDS label for patients still ill with functional limitations after 3 weeks of doxycycline. The term implies that the infection has cleared.

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