Lyme Carditis: Complete Heart Block May Be an Early Sign
Lyme carditis can cause heart block, fainting, and palpitations
Symptoms may appear even when classic Lyme signs are absent
Early recognition may prevent unnecessary permanent pacemaker placement
Lyme carditis often presents with non-specific symptoms, such as lightheadedness, syncope, dyspnea, palpitations, and chest pain, the authors explain. While an estimated 30% of patients exhibit no symptoms, others may present with rapidly progressive conduction abnormalities requiring urgent evaluation.
The most common clinical manifestation “is AV block, which can be acute in onset and can rapidly progress to complete heart block,” writes Carnazzo.
In their article, “Lyme disease presenting as complete heart block in a young man: Case report and review of pathogenesis,” Carnazzo and colleagues discuss the case of a 37-year-old man who developed complete heart block as a complication of Lyme disease months after several tick bites.
Why Lyme Carditis Can Be Missed
Clinical suspicion for Lyme carditis should remain high in adults with unexplained high-grade heart block, particularly in Lyme-endemic areas.
Lyme carditis can be difficult to recognize when classic signs of Lyme disease are absent or when patients do not recall a tick bite or erythema migrans rash. Diagnostic delays may increase the risk of serious complications and unnecessary interventions. Learn more about delayed Lyme disease diagnosis.
Case Presentation: Complete Heart Block in a 37-Year-Old Man
The case report describes a 37-year-old man living in northwestern Wisconsin who presented to the emergency department with two episodes of syncope without prodromal symptoms over a 5-day period.
“During these days, he had increasingly frequent episodes of dizziness and near-syncope,” writes Carnazzo.
He also reported fever, chills, muscle aches, and bilateral lower extremity erythematous rash that had developed 3 weeks earlier but had resolved by presentation.
Two months before symptom onset, he had removed several ticks from his left thigh and groin.
Diagnosis and Treatment of Lyme Carditis Heart Block
An electrocardiogram (ECG) revealed complete heart block, prompting insertion of a temporary pacemaker.
The patient was diagnosed with Lyme carditis after testing positive for B. burgdorferi on Western blot and was treated successfully with intravenous ceftriaxone.
After 9 days, the heart block completely resolved.
Patients with symptoms such as palpitations, dizziness, syncope, or changing heart rates may also have broader manifestations of Lyme carditis without typical symptoms.
Clinical Features That Should Raise Suspicion for Lyme Carditis
- Syncope or near-syncope
- Lightheadedness or dizziness
- Palpitations
- Shortness of breath
- Chest pain
- New AV block or conduction abnormalities
- Recent tick exposure or outdoor exposure history
- History of rash, fever, fatigue, chills, or muscle aches
Neurologic symptoms, dysautonomia, and cardiac manifestations may overlap in disseminated disease. Review additional information on neurologic Lyme disease.
Frequently Asked Questions
Can Lyme disease cause complete heart block?
Yes. Lyme carditis can cause conduction abnormalities ranging from first-degree AV block to complete heart block.
What are common Lyme carditis symptoms?
Symptoms may include dizziness, fainting, palpitations, chest pain, fatigue, shortness of breath, or syncope.
Can Lyme carditis resolve with antibiotics?
Yes. Many patients improve with prompt antibiotic treatment, and conduction abnormalities may reverse after therapy.
Can Lyme carditis occur without a rash?
Yes. Some patients never recall a tick bite or erythema migrans rash, making diagnosis more difficult.
Can Lyme carditis require a pacemaker?
Temporary pacing may be necessary in severe cases, but early diagnosis may help avoid unnecessary permanent pacemaker placement.
Clinical Takeaway
Lyme carditis can lead to rapidly progressive conduction abnormalities, including complete heart block, even when classic Lyme disease symptoms are absent.
Recognizing syncope, palpitations, dizziness, and unexplained AV block early may allow prompt treatment and reduce unnecessary permanent pacemaker placement.
Related Articles
These related articles explore Lyme carditis presentations, heart block, delayed recognition, and broader symptom patterns.
Successful removal of pacemakers for Lyme carditis
Lyme carditis causes complete heart block in a 26-year-old man
Lyme carditis
Lyme disease symptoms guide
Lyme disease misdiagnosis
References
- Carnazzo MC, Scholin C, Shweta F, Calvin AD. Lyme disease presenting as complete heart block in a young man: Case report and review of pathogenesis. IDCases. 2023;32:e01799.
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
Does the COVID-19 vaccination increase the incidence of Carditis for those with Lyme disease since both the shot and Lyme infection are indicated as risk factors for heart injury?
I don’t know the answer, yet.
Dr. Cameron good afternoon. I have been experiencing low blood pressure for two weeks and as of yesterday when bending over my blood pressure was very high and I was rather short of breath like I was getting no air. I am also ridiculously tired from the babesia I. I sweat profusely day and night during the day. It’s when I bend over and it just pours from my temple areas in my head and my face has been bilaterally. Numb for about four months where before that it was just one spot on my left cheek bone I am wondering if this is related if you have an answer or any ideas for me I’d sure appreciate your response. Thank you have a great day.
Excellent case report on Lyme carditis, similar to cases seen in SE Massachusetts. They deserve IV ceftriaxone, just as done, even if the heart block doesn’t resolve.