What You Need to Know about Lyme Carditis
Lyme disease is caused by a spiral-shaped bacterium called
Borrelia burgdorferi. It is transmitted to humans by the bite of tiny,
infected blacklegged ticks, commonly known as deer ticks.
Given that in the United States Lyme disease is the most commonly reported
vector-borne illness — an infection transmitted by a living organism — it’s
not surprising that many people are now aware of its early flu-like
symptoms and the potential for joint and neurological issues when left
Not as well-known is a much less common and potentially deadly complication
of Lyme disease involving the
heart: Lyme carditis.
“Of all the different non-skin manifestations of Lyme disease, I would say
it’s the least common,” acknowledges Jonathan A. Edlow, MD (right), an emergency physician at Beth Israel Deaconess Medical Center
(BIDMC) and author of Bull’s Eye: Unraveling the Medical Mystery of Lyme Disease. “It
usually occurs in younger men for reasons that are not clear, and it
usually presents with heart block.”
Heart block occurs when Borrelia burgdorferi bacteria enter heart tissue
and interfere with normal electrical signals that coordinate the beating of
the heart. There are
three degrees of heart block
: first degree may not have any symptoms; second degree may result in
skipped heartbeats; and third degree reduces the amount of blood pumped
through the body. Third-degree heart block can be fatal and requires prompt
Cardiac Manifestations of Tick Disease
, an article written by
Duane S. Pinto, MD, MPH
(right), a cardiovascular disease specialist at BIDMC, about four to 10
percent of people with untreated Lyme disease will develop carditis. It
usually occurs in June through December, and within four days to seven
months after a tick bite.
Symptoms of Lyme carditis
include light-headedness, fainting, shortness of breath, heart palpitations
and chest pain. Complicating the issue is that someone suffering from Lyme
carditis may not even realize that they have Lyme disease in the first
Such was the case in
three instances of sudden death
associated with Lyme carditis between November 2012 and July 2013. The two
men and one woman, ranging in age from 26 to 38 years, lived in the
high-incidence Lyme disease states of Massachusetts, New York and
The first two patients were organ donors, which led to the discovery of
Lyme carditis by pathologists at a tissue bank. The third patient’s heart
tissue was evaluated for suspected viral myocarditis, during which Lyme
carditis was confirmed.
Prompt Treatment Proves Successful
Despite these known fatalities from untreated Lyme carditis, the outlook
for recovering from this condition is generally excellent and symptoms
typically resolve with one to six weeks after the start of antibiotic
therapy. Patients with second- or third-degree heart block may require a
temporary pacemaker and hospitalization.
Lyme carditis symptoms typically show up in conjunction with the common
early Lyme disease symptoms of fever, chills, headache, fatigue, muscle and
joint aches, swollen lymph nodes and a bull’s eye-like skin rash that
starts at the site of the bite.
According to Dr. Pinto, a Lyme carditis diagnosis is usually made by
confirming the clinical features of Lyme disease in the presence of cardiac
findings such as electrocardiographic abnormalities, chest pain, congestive
heart failure, palpations and fainting episodes.
Dr. Edlow says patients who are symptomatic with Lyme carditis typically
have a higher degree of heart block and are initially treated with
intravenous antibiotics before switching to oral antibiotics, which is the
standard treatment for Lyme disease.
Lyme Disease on the Rise
Although about 30,000 new cases of Lyme disease are reported each year, the
Centers for Disease Control and Prevention say the actual number may be
closer to 300,000.
New England is one of the highest risk areas and it’s important to take
precautions when heading outdoors. Blacklegged ticks prefer grassy and
wooded areas, so avoid walking through bushes and other vegetation whenever
possible. A repellent with DEET can be used on skin or clothing, and
permethrin can be used on clothing or gear.
Always check yourself for ticks if you have been outdoors. Pets can bring
ticks into your home, so check them as well. If you find an attached tick,
remove with a pair of fine-tip tweezers. A blacklegged tick typically needs
to be attached to the skin for at least 24 hours to transmit Lyme disease.
Be sure to see your healthcare provider if you develop any symptoms such as
fever or a bull’s eye rash.
With the proper preventive measures, it’s possible to enjoy the great
outdoors this summer while protecting your heart and overall health.
If you or your doctor think you may have Lyme carditis, call the CVI's
Cardiovascular Clinic for an appointment at 617-667-8800.
Above content provided by the CardioVascular Institute at Beth Israel
Deaconess Medical Center. For advice about your medical care, consult