Three deaths associated with Lyme carditis were documented by the CDC between November 2012 and July 2013. All three patients were diagnosed on autopsy after sudden cardiac death. These cases demonstrate how Lyme carditis can be fatal when unrecognized — and why maintaining clinical suspicion in endemic areas can save lives.

Inside Lyme Podcast: Three Deaths Associated with Lyme Carditis

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing three deaths associated with Lyme carditis.

The CDC Report

I first read about these cases in the Morbidity and Mortality Weekly Report (MMWR) published by the Centers for Disease Control and Prevention (CDC).

The authors described three deaths associated with Lyme disease. All three were diagnosed with Lyme carditis on autopsy — meaning the diagnosis wasn’t made until after death. This represents the ultimate diagnostic failure: recognition only at autopsy.

These weren’t the first deaths from Lyme carditis, but their publication in the CDC’s weekly report brought national attention to how Lyme carditis can be fatal when unrecognized.

Patient 1: Massachusetts Resident

“In November 2012, a Massachusetts resident was found unresponsive in an automobile after it veered off the road,” wrote the authors. He had no cardiac activity when emergency responders arrived. He was pronounced dead at a nearby hospital.

We know very little about the patient. “Interviews with next-of-kin revealed that the patient had described a nonspecific illness with malaise and muscle and joint pain during the 2 weeks preceding death,” wrote the authors.

The authors added, “The patient lived alone with a dog that was reported to have ticks frequently.”

He was diagnosed with Lyme carditis on autopsy.

What We Can Learn from Patient 1

This patient had two weeks of symptoms before sudden death. Malaise, muscle pain, and joint pain are classic early Lyme disease symptoms. Combined with the tick exposure through his dog, this should have raised suspicion for Lyme disease.

But the patient lived alone. There’s no indication he sought medical care during those two weeks of illness. Did he dismiss his symptoms as flu? Was he unable to access care? Did he not realize the symptoms warranted evaluation?

The dog detail is significant. Dogs bring ticks into homes, increasing human exposure. When someone lives with a dog in an endemic area and develops systemic symptoms, Lyme disease should be considered.

Patient 2: New York Resident

“In July 2013, a New York state resident experienced chest pain and collapsed at home,” wrote the authors. The patient was pronounced dead after failing cardiopulmonary resuscitation.

The patient had a history of Wolff-Parkinson-White syndrome (WPW). WPW is a condition characterized by abnormal electrical pathways that can cause a rapid heartbeat. There was no history of a tick bite or a rash.

The patient was also diagnosed with Lyme carditis on autopsy.

What We Can Learn from Patient 2

The pre-existing WPW likely created diagnostic confusion. When this patient developed cardiac symptoms, clinicians would naturally attribute them to the known WPW rather than considering a new diagnosis like Lyme carditis.

This illustrates how pre-existing cardiac conditions can mask Lyme carditis. The assumption that “we know why you have heart problems — you have WPW” prevents consideration of a new, treatable infection.

The absence of tick bite or rash history is also instructive. Most Lyme carditis patients don’t recall these classic markers, yet they’re often treated as requirements for diagnosis.

Patient 3: Connecticut Resident

“In July 2013, a Connecticut resident collapsed while visiting New Hampshire and was pronounced dead at a local hospital,” wrote the authors.

“The patient had complained of episodic shortness of breath and anxiety during the 7–10 days before death,” wrote the authors. He was prescribed the anti-anxiety medication clonazepam the day prior to death. There was no EKG performed.

The patient was diagnosed with Lyme carditis on autopsy.

What We Can Learn from Patient 3

This case represents medical abandonment. A patient presents with episodic shortness of breath — a cardiac symptom — and leaves with an anxiety diagnosis and benzodiazepine prescription. No EKG was performed.

If an EKG had been done during that visit 7-10 days before death, would it have shown heart block? Almost certainly. Lyme carditis causes progressive conduction abnormalities that would be visible on EKG days before cardiac arrest.

This patient died the day after being prescribed clonazepam for “anxiety.” His cardiac symptoms were dismissed as psychiatric. This is a pattern I see repeatedly: cardiac symptoms attributed to anxiety, especially in younger patients, without basic cardiac workup.

Common Threads in Three Deaths

All three of these individuals tested positive for Lyme disease on autopsy. What patterns emerge from these cases?

• All occurred in endemic areas: Massachusetts, New York, Connecticut — classic Lyme disease territory
• All had symptoms before death: 2 weeks of systemic symptoms, chest pain, episodic shortness of breath
• None were diagnosed before death: Lyme carditis only recognized on autopsy
• Classic markers were absent: No documented tick bites or rashes
• Symptoms were dismissed or misattributed: WPW blamed, anxiety diagnosed, flu-like illness ignored

These deaths were preventable. Each patient had a window of opportunity when recognition and treatment could have saved their life.

Questions These Cases Raise

What questions do these cases raise?

1. What is Lyme carditis?
2. How often does Lyme carditis occur?
3. How is Lyme disease diagnosed?
4. Can Lyme carditis be prevented?
5. How often are autopsies performed on patients with sudden death?
6. Why is the second patient’s history of Wolff-Parkinson-White syndrome (WPW) important?
7. How reliable are tests for Lyme disease in patients with sudden death?
8. Could the third patient still be alive if he had an EKG 7 to 10 days earlier when he presented with episodic shortness of breath and anxiety?
9. What is the significance of the dog in the first case?
10. What would you recommend?

Clinical Perspective

These three deaths haunt me. Each represents a missed opportunity for diagnosis and treatment. Each patient had clues that should have prompted Lyme disease consideration.

Patient 1 had two weeks of systemic symptoms with tick exposure through his dog. Patient 2 had chest pain in an endemic area. Patient 3 had episodic shortness of breath diagnosed as anxiety without even an EKG.

The third case particularly troubles me. A patient complains of episodic shortness of breath — an obviously cardiac symptom — and receives a psychiatric diagnosis without basic cardiac evaluation. This reflects the broader problem of medical dismissal in Lyme disease care.

If that physician had done an EKG, the heart block would have been visible. If Lyme disease had been considered in an endemic area, empiric treatment could have started. The patient died less than 24 hours after that visit.

These cases changed CDC surveillance and reporting. They prompted increased awareness about Lyme carditis as a medical emergency. But deaths continue to occur when the diagnosis isn’t considered.

The lesson is clear: in endemic areas, unexplained cardiac symptoms — especially in young adults — require Lyme disease evaluation. An EKG is mandatory. Empiric treatment should begin if clinical suspicion is reasonable. Don’t wait for perfect test confirmation. Don’t assume symptoms are anxiety without ruling out cardiac pathology.

These three patients didn’t have to die. Lyme carditis is treatable. But only if we recognize it in time.

Frequently Asked Questions

How common are deaths from Lyme carditis?

Rare, but documented. The CDC has identified multiple fatal cases, though the true number is likely underreported. Most deaths involve diagnostic delays or failure to recognize cardiac involvement. When treated promptly, Lyme carditis is highly treatable and deaths are preventable.

Can you die suddenly from Lyme carditis without warning symptoms?

No. All three deaths in this CDC report involved symptoms before cardiac arrest: 2 weeks of systemic illness, chest pain, or episodic shortness of breath. Lyme carditis gives warnings, but those warnings are often dismissed or misdiagnosed.

Why were these patients only diagnosed on autopsy?

Lyme carditis wasn’t considered during life. One patient’s symptoms were attributed to pre-existing WPW. Another received an anxiety diagnosis without cardiac workup. The third lived alone and may not have sought care. Diagnosis at autopsy represents complete diagnostic failure.

Could an EKG have saved the third patient’s life?

Almost certainly. He presented with episodic shortness of breath 7-10 days before death. An EKG would have revealed heart block requiring immediate treatment. Instead, he received clonazepam for anxiety and died the next day. This is medical abandonment.

Do most Lyme carditis patients remember a tick bite or have a rash?

No. In this CDC report, none of the fatal cases had documented tick bite or rash. Most Lyme carditis patients lack these classic markers. Waiting for tick bite or rash before considering Lyme disease contributes to diagnostic delays and deaths.

Why is the dog important in the first case?

Dogs bring ticks into homes, increasing human exposure to Lyme disease. A patient in an endemic area living with a tick-infested dog who develops systemic symptoms deserves Lyme disease evaluation regardless of whether they recall a specific tick bite.

Should young adults with cardiac symptoms always be evaluated for Lyme disease?

Yes, in endemic areas. Unexplained cardiac symptoms in young patients — especially chest pain, syncope, palpitations, or shortness of breath — warrant Lyme testing and often empiric treatment. Young males are at highest risk for Lyme carditis.

What would have prevented these three deaths?

Clinical suspicion for Lyme disease in endemic areas. Basic cardiac workup (EKG) for cardiac symptoms. Empiric treatment when Lyme carditis is considered. Not dismissing symptoms as anxiety without ruling out cardiac pathology. These deaths were preventable with appropriate medical care.

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.