Heart / Cardiac and Lyme
Cardiovascular manifestations include: fluctuating degrees of atrioventricular (AV) block, acute myopericarditis, ventricular dysfunction, rarely cardiomegaly or fatal pericarditis. Myocarditis, cardiomyopathy and degenerative valvular disease.
See fatalities link for deaths related to Cardiac & Lyme
See below for a selection of abstracts on other heart related Lyme problems:
Complete heart block due to lyme carditis.
J Invasive Cardiol. 2003 Jun;15(6):367-9.
Lo R, Menzies DJ, Archer H, Cohen TJ.
Source: Section of Electrophysiology in the Division of Cardiology, Department of
Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA.
Abstract: Lyme carditis is becoming a more frequent complication of Lyme disease, primarily due to the increasing incidence of this disease in the United States. Cardiovascular manifestations of Lyme disease often occur within 21 days of exposure and include fluctuating degrees of atrioventricular (AV) block, acute myopericarditis or mild left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis. AV block can vary from first-, second-, third-degree heart block, to junctional rhythm and asystolic pauses. Patients with suspected or known Lyme disease presenting with cardiac symptoms, or patients in an endemic area presenting with cardiac symptoms with no other cardiac risk factors should have a screening electrocardiogram along with Lyme titers. We present a case of third-degree AV block due to Lyme carditis, illustrating one of the cardiac complications of Lyme disease. This disease is usually self-limiting when treated appropriately with antibiotics, and does not require permanent cardiac pacing.
J Invasive Cardiol. 2003 Jun;15(6):367-9.
Lo R, Menzies DJ, Archer H, Cohen TJ.
Source: Section of Electrophysiology in the Division of Cardiology, Department of
Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA.
Abstract: Lyme carditis is becoming a more frequent complication of Lyme disease, primarily due to the increasing incidence of this disease in the United States. Cardiovascular manifestations of Lyme disease often occur within 21 days of exposure and include fluctuating degrees of atrioventricular (AV) block, acute myopericarditis or mild left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis. AV block can vary from first-, second-, third-degree heart block, to junctional rhythm and asystolic pauses. Patients with suspected or known Lyme disease presenting with cardiac symptoms, or patients in an endemic area presenting with cardiac symptoms with no other cardiac risk factors should have a screening electrocardiogram along with Lyme titers. We present a case of third-degree AV block due to Lyme carditis, illustrating one of the cardiac complications of Lyme disease. This disease is usually self-limiting when treated appropriately with antibiotics, and does not require permanent cardiac pacing.
Cardiac implications of Lyme disease, diagnosis and therapeutic approach.
Int J Cardiol. 2008 Sep 16;129(1):15-21. doi: 10.1016/j.ijcard.2008.01.044. Epub 2008 May 27.
Lelovas P, Dontas I, Bassiakou E, Xanthos T.
Source: Laboratory for Research of the Musculoskeletal System, University of Athens,
School of Medicine, Greece.
Abstract: Lyme is a tick-borne disease. The genetic diversity of Borreliae its distribution worldwide and its epidemiology have been related to different clinical manifestations. Carditis is a rare manifestation of Lyme disease. The commonest abnormality is atrioventricular block of various degrees, though other rhythm abnormalities have been reported. Pericarditis, myocarditis, cardiomyopathy and degenerative valvular disease have been associated with B. burgdorferi. Temporary pacing might be required in unstable patients. The majority of the conduction disturbances have a benign prognosis, if the
infectious agent is identified and treated appropriately.
Int J Cardiol. 2008 Sep 16;129(1):15-21. doi: 10.1016/j.ijcard.2008.01.044. Epub 2008 May 27.
Lelovas P, Dontas I, Bassiakou E, Xanthos T.
Source: Laboratory for Research of the Musculoskeletal System, University of Athens,
School of Medicine, Greece.
Abstract: Lyme is a tick-borne disease. The genetic diversity of Borreliae its distribution worldwide and its epidemiology have been related to different clinical manifestations. Carditis is a rare manifestation of Lyme disease. The commonest abnormality is atrioventricular block of various degrees, though other rhythm abnormalities have been reported. Pericarditis, myocarditis, cardiomyopathy and degenerative valvular disease have been associated with B. burgdorferi. Temporary pacing might be required in unstable patients. The majority of the conduction disturbances have a benign prognosis, if the
infectious agent is identified and treated appropriately.
Persistent atrioventricular block in Lyme borreliosis.
Klin Wochenschr. 1990 Apr 17;68(8):431-5.
Mayer W, Kleber FX, Wilske B, Preac-Mursic V, Maciejewski W, Sigl H, Holzer E, Doering W.
Source: Krankenhaus München-Schwabing, Akademisches Lehrkrankenhaus,
Ludwig-Maximilians-Universität München.
Abstract: Cardiac manifestations are reported in 0.3%-4.0% of European patients with Borrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. Diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.
Klin Wochenschr. 1990 Apr 17;68(8):431-5.
Mayer W, Kleber FX, Wilske B, Preac-Mursic V, Maciejewski W, Sigl H, Holzer E, Doering W.
Source: Krankenhaus München-Schwabing, Akademisches Lehrkrankenhaus,
Ludwig-Maximilians-Universität München.
Abstract: Cardiac manifestations are reported in 0.3%-4.0% of European patients with Borrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. Diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.
Lyme carditis: an important cause of reversible heart block.
Ann Intern Med. 1989 Mar 1;110(5):339-45.
McAlister HF, Klementowicz PT, Andrews C, Fisher JD, Feld M, Furman S.
Source: Montefiore Medical Center, Bronx, New York.
Abstract: Lyme disease is a tick-borne spirochetal infection, characterized by erythema chronicum migrans and an acute systemic illness. The disease is endemic in many parts of the north-eastern United States. Without treatment, late rheumatic, neurologic, and cardiac complications frequently occur. We report four serologically confirmed cases of Lyme carditis in previously healthy young men (mean age, 45 years) from endemic areas. Each presented with severe symptomatic atrioventricular block, three with episodes of prolonged ventricular asystole. Two had permanent pacemakers implanted (one was later removed), and another, very nearly did, before diagnosis. All four patients were treated with antibiotics, and in each case their rhythm returned to sinus, though one patient has Wenckebach second degree block with atrial pacing at 120 beats/min 16 months later. Carditis occurs in 4% to 10% of cases of Lyme disease and usually begins
3 to 6 weeks after the initial illness. It manifests as a transient myocarditis with varying degrees of atrioventricular block. The diagnosis is made primarily on clinical grounds and confirmed by serologic testing. Temporary cardiac pacing is frequently needed by patients who have severe heart block with hemodynamic instability. The evidence suggests that, in most cases, the block is at the level of the atrioventricular node. The block generally resolves completely with antibiotic treatment. Complete heart block rarely persists more than 1 week and the long-term prognosis appears to be excellent. Consideration and prompt recognition of this potentially lethal, but reversible, cause of heart block is crucial in order to avoid inappropriate permanent pacemaker implantation.
Ann Intern Med. 1989 Mar 1;110(5):339-45.
McAlister HF, Klementowicz PT, Andrews C, Fisher JD, Feld M, Furman S.
Source: Montefiore Medical Center, Bronx, New York.
Abstract: Lyme disease is a tick-borne spirochetal infection, characterized by erythema chronicum migrans and an acute systemic illness. The disease is endemic in many parts of the north-eastern United States. Without treatment, late rheumatic, neurologic, and cardiac complications frequently occur. We report four serologically confirmed cases of Lyme carditis in previously healthy young men (mean age, 45 years) from endemic areas. Each presented with severe symptomatic atrioventricular block, three with episodes of prolonged ventricular asystole. Two had permanent pacemakers implanted (one was later removed), and another, very nearly did, before diagnosis. All four patients were treated with antibiotics, and in each case their rhythm returned to sinus, though one patient has Wenckebach second degree block with atrial pacing at 120 beats/min 16 months later. Carditis occurs in 4% to 10% of cases of Lyme disease and usually begins
3 to 6 weeks after the initial illness. It manifests as a transient myocarditis with varying degrees of atrioventricular block. The diagnosis is made primarily on clinical grounds and confirmed by serologic testing. Temporary cardiac pacing is frequently needed by patients who have severe heart block with hemodynamic instability. The evidence suggests that, in most cases, the block is at the level of the atrioventricular node. The block generally resolves completely with antibiotic treatment. Complete heart block rarely persists more than 1 week and the long-term prognosis appears to be excellent. Consideration and prompt recognition of this potentially lethal, but reversible, cause of heart block is crucial in order to avoid inappropriate permanent pacemaker implantation.
