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.

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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"

  • Rajkumar Ghosh
    03/08/2024 (5:14 am)

    This is a helpful information for us. Thanks for sharing it.

  • Annemiek
    11/14/2023 (6:06 pm)

    Could you please pay attention in one of your much respected blogs to lyme induced costochondritis?

    • Dr. Daniel Cameron
      11/15/2023 (7:52 am)

      Thanks. There is not much written in the literature to discuss in a blog. I approach costochondritis in my Lyme patients by ruling out a cardiac cause. I approach costochondritis in my Lyme disease patients as I would for synovitis and bursitis.

  • Elaine
    01/11/2023 (12:22 am)

    I was diagnosed with ALS in November and I am devastated as you can imagine. I found an engorged deer tick on my back in 2020. I was given 2 doses of doxycycline. I have had about 3 Lyme tests, all negative. Symptoms are very similar to Als. Weakness, slurred speech, twitching. Any comments? What do you think?

    • Dr. Daniel Cameron
      01/11/2023 (8:11 am)

      I have not been convinced a single 200 mg dose of doxycycline prevents more than a rash. I have also been concerned that a single dose of doxycycline may interfere with the testing. I advise my patients to look at Lyme disease a second time in addition to working with their neurologist even if the tests are negative.

  • Colleen Schake
    06/14/2022 (11:02 am)

    I realize I’m posting on an old feed, but didn’t see any comments asking if a loop recorder might help in these cases when palpitations, bradycardia and tachycardia are apparent but dismissed as not being dangerous. It seems they only look for afib?
    I’m reading the devices can cause heart and or vessel issues, so is it worth the risk? Or should we be asking for some other type of tests?

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