Mitral valve dysfunction from Lyme carditis

Heart valve involvement can occur in Lyme carditis
Cardiac symptoms may mimic other serious heart conditions
Prompt treatment may improve cardiac recovery

The 22-year-old man was admitted to the hospital with cardiac symptoms including chest pain and lightheadedness. He suffered from morbid obesity and complained of symptoms for several days. During his examination, he was sweaty with a fast pulse of 115. He also reported having an erythema migrans (EM) rash.

Clinicians initially suspected a myocardial infarction and prescribed intravenous heparin, the authors explain in the case report, “Early Onset Lyme Myopericarditis With Left Ventricular Dysfunction and Mitral Regurgitation.”

“Echocardiogram was done which showed a left ventricular ejection fraction (LVEF) of 49% with mild diffuse hypokinesis, and moderate to severe mitral regurgitation,” the authors wrote.

Test results were positive for Lyme disease and the man was treated with intravenous ceftriaxone.

“If left untreated, Lyme carditis can lead to acute heart failure and sudden cardiac death thus prompt diagnosis and treatment are essential in management.”

A repeat echocardiogram showed improvement of the previously visualized mitral regurgitation and normalization of LVEF.

The patient had marked improvement in symptoms and resolution of his rash. He was discharged home with a 3-week course of oral doxycycline.

“On a 1-month follow-up, patient remains asymptomatic and is back to his previous baseline,” according to the authors.

Can Lyme disease affect the heart?

Cardiac manifestations in Lyme disease typically occur 1 to 2 months after onset of infection, the authors wrote. In this case, however, Lyme carditis developed a little over 1 week after known tick exposure.

A growing number of cardiac manifestations due to Lyme disease have been described. Clinical manifestations include arrhythmias, conduction abnormalities, myopericarditis, ventricular dysfunction, and acute heart failure.

Patients with Lyme carditis may report chest pain, palpitations, dizziness, fainting, shortness of breath, or exercise intolerance.

Patients with suspected Lyme carditis may also present with symptoms described in Lyme carditis diagnosis: 18 cases or broader cardiac symptoms discussed in Lyme disease chest pain.

“Left ventricular dysfunction, as seen in our patient, has been reported to have an incidence of 0.5%.”

Valvular dysfunction due to Lyme carditis is rare. “To date, about 7 cases of valvular involvement in Lyme carditis have been reported making this phenomenon exceedingly rare.”

Most cases of Lyme carditis involve conduction abnormalities, making valve involvement more difficult to recognize early.

“If there is a high suspicion for Lyme carditis, empiric treatment with antibiotics should be started while the initial evaluation is pending.”

Death from Lyme carditis is rare. “A case series published by the CDC reported 3 individual deaths that were attributed to Lyme disease by postmortem examination indicating that lack of treatment can lead to fatalities.”

Shen and colleagues described the death of a 25-year-old man with Lyme carditis. “He presented with syncope and second-degree Mobitz type 2 heart block, as well as disseminated erythema migrans rash.”²

The patient received a temporary pacemaker and was discharged after 4 days of intravenous ceftriaxone.

“The patient returned home to a different state and reportedly died at home about 1 week after discharge.” There was no autopsy report or records to determine the cause of death.

Frequently Asked Questions

Can Lyme disease cause a heart murmur?

Lyme disease can rarely contribute to valvular abnormalities that may be associated with a murmur. In this case, mitral regurgitation improved following antibiotic treatment.

Can Lyme disease affect heart valves or cause valve problems?

Valve involvement appears uncommon but has been reported. Most cases of Lyme carditis involve conduction abnormalities rather than valve dysfunction.

Can Lyme disease cause chest pain or palpitations?

Yes. Lyme carditis may lead to chest pain, palpitations, dizziness, fainting, shortness of breath, or abnormal heart rhythms.

Can Lyme carditis lead to heart failure?

Rarely. Severe cases may involve ventricular dysfunction, arrhythmias, or heart failure, emphasizing the importance of early recognition.

Clinical Takeaway

Lyme carditis most commonly causes conduction abnormalities, but rare cases may involve ventricular dysfunction and valve abnormalities such as mitral regurgitation. Cardiac symptoms developing after tick exposure or an erythema migrans rash warrant careful evaluation.

Rare cardiac manifestations of Lyme disease may mimic other serious heart conditions, making early recognition and treatment especially important.

Related Articles

Patients can die when Lyme carditis is not treated
Can Lyme disease cause chest pain?
Heart palpitations and Lyme disease
Shortness of breath and Lyme disease

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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