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How Is Lyme Carditis Diagnosed

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How Common Is Lyme Carditis

The ECG in Lyme Carditis

Around 1 in every 100 people infected with Lyme disease develops Lyme carditis. Since there are estimated to be around 30,000 cases of Lyme disease each year, this means about 300 will develop Lyme carditis.

This means the condition isnt common and wont affect even close to everyone infected with Lyme disease. However, this also means not much research has been done on Lyme carditis, how it works, or why some people develop it while others dont.

Skin Examinations And Ecgs

Thorough dermatological examination can clarify difficult cases. This happened in my clinic recently, when a nurse practitioner decided to run a full skin examination and discovered typical bulls-eye rashes on the patients back.

Once the diagnosis is suspected, cardiovascular symptoms such as dizziness, palpitations, fainting or near fainting, chest pain and shortness of breath should be investigated. If the patient reports any of these symptoms, along with any other factors suggesting Lyme disease, a 12-lead ECG should be performed.

Quite recently, a team from the United States did 12-lead ECG to a large series of pediatric patients presenting to the emergency department with high-suspicion of Lyme disease, and discovered that nearly 30 per cent of them had some conduction disturbance. Any evidence of electrical disturbance should prompt admission in hospital for a course of intravenous antibiotics while waiting the results of serological tests.

From the other perspective, any patient presenting with unexpected high-degree atrioventricular block , the way to test for Lyme carditis is by running a risk score called SILC , which was developed at Queens University and is now used worldwide.

SILC score is based on the risk factor acronym COSTAR , which may help in determining the likelihood of early Lyme carditis.

What Is Lyme Carditis

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the hearts upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call heart block, which can vary in degree and change rapidly. Lyme carditis occurs in approximately one out of every hundred Lyme disease cases reported to CDC.

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Secondary Symptoms Of Lyme Carditis

Secondary symptoms of Lyme carditis are generally related to Lyme disease. These symptoms often appear first, but they may co-occur with primary symptoms in some cases. Common secondary symptoms include:

  • Swollen lymph nodes

Not every person develops the same symptoms after being infected by the bacteria causing Lyme disease. Your symptoms may include all the above or only a few of them.

Confirming Lyme Disease In The Age Of Covid

Lyme carditis: A cant miss diagnosis

The current COVID-19 pandemic is posing a new challenge in the diagnosis of Lyme disease. The two conditions have a lot of overlapping symptoms, such as fever, malaise, generalized pain and lack of energy. During these times, its advisable to rule out COVID-19 first before embarking on any other test.

Asking focused questions about personal lifestyle may help guiding the diagnosis of Lyme disease. Some key questions include:

  • Any outdoor activities in areas already identified as having high prevalence of ticks?
  • Any recollection of tick bites or removal of ticks from the body?
  • Any skin rashes? ,
  • Do you live in an endemic region for Lyme disease? If youre not sure, you can check public health websites. Knowing if one lives in an endemic region for Lyme disease is essential, as these recommendations should be encouraged in all emergency departments and family doctors offices in areas of high prevalence.

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Lyme Carditis: Sequential Electrocardiographic Changes In Response To Antibiotic Therapy

  • Ijaz A. KhanCorrespondenceCorresponding author. Division of Cardiology, Good Samaritan Hospital, 5601 Loch Raven Boulevard, Baltimore, Maryland 21239, USA. Tel.: +1 43 44 607 fax: +1 410 532 4606.

How Does Lyme Carditis Occur

When the spirochete bacteria Borrelia burgdorferi invades the heart tissue, it causes Lyme carditis. The bacteria can affect all the components of the heart, including the conduction system, the inner and outer membranes, the cardiac muscle, blood vessels, and heart valves. The immune system responds to the bacterias presence with a cascade of immune cells and cytokines, which results in oxidative damage and inflammation.

The most common manifestation of Lyme carditis is an electrical conduction block from the upper heart chambers to the lower heart chambers called an atrioventricular block. The electrical signal to the chamber that pumps blood throughout the body is delayed contributing to cardiovascular symptoms. Heart blocks are classified as first, second, and third-degree AV blocks and can rapidly fluctuate between degrees.

People with higher degree AV blocks are more likely to have more severe symptoms. One study found 54% of people with Lyme carditis had high-grade or complete AV block. In another study, 49% of people with Lyme carditis developed complete AV block. This means about half of people with Lyme carditis will develop complete heart block and require a pacemaker if treatment for Lyme disease is not promptly initiated.

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Treatment Of Lyme Carditis

Lyme carditis is fully reversible with timely and appropriate antibiotic therapy: most cases of AVB resolve within the first 10 days of antibiotic administration. The choice of antibiotic treatment varies based on the severity of the presentation . Treatment should be started immediately after Lyme carditis has been clinically diagnosed. It is especially important not to wait for serology results before initiating antibiotic treatment because increased morbidity and mortality can occur, as seen in a recent case of Lyme carditis in New England.

Because the AVB is fully reversible with appropriate antibiotic therapy, permanent pacemaker placement is usually not indicated for Lyme carditis, though a temporary transvenous pacemaker is required in 33% of cases. The indications for temporary pacing are symptomatic bradycardia, hemodynamic instability, or high-risk features on ECG, such as alternating bundle branch block. With appropriate antibiotic treatment, AV conduction is restored in a stepwise fashion from-third degree AVB , to second-degree AVB , then first-degree AVB , then back to normal.

How Long Does It Take For Lyme Disease To Affect Your Heart

What is the Best Treatment for Lyme Carditis?

According to a 2022 review , if Lyme disease affects the heart, it does so within several weeks or months of the initial infection.

If a person notices a tick bite, they should monitor themselves closely for any symptoms of Lyme disease. These include:

  • a growing bulls-eye rash

Symptoms of a heart problem resulting from Lyme disease may include fainting, chest pains, and heart palpitations. This could indicate Lyme carditis.

If a person suspects Lyme disease or Lyme carditis, they should contact a medical professional as soon as possible.

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Lyme Carditis: What Is It Symptoms And Treatments

Shutterstock/New Africa

  • Lyme carditis happens when the bacteria causing Lyme disease travels to the heart.
  • Common symptoms of Lyme carditis include difficulty breathing, irregular heart rate, fainting, and chest pain.
  • Symptoms of Lyme carditis often happen after a person has shown signs or received a diagnosis of Lyme disease.
  • Treatment involves antibiotics and, in severe cases, the placement of a temporary pacemaker.
  • Although Lyme carditis can be fatal, the disease responds well to modern treatments if caught early.

If you or a loved one have been diagnosed with Lyme carditis, you likely have questions about the disease and how its treated. Before learning of this condition, you may or may not have already known you had Lyme disease. These two diseases are intricately linked, so the best option in preventing Lyme carditis is to prevent Lyme disease.

Below youll find the answers to all your most pressing questions about both these illnesses and how you can prevent them from happening. Lets get into it!

How Lyme Disease Leads To Lyme Carditis

When an infected tick bites you, it transfers one of four different bacteria to your skin and bloodstream. This bacteria can then multiply inside your body, causing a range of symptoms and complications.

Most people infected with these bacteria have mild to moderate symptoms revolving mainly around the skin and joints. However, in a small percentage of those infected with Lyme disease, the bacteria travel to the heart. This can happen over time if Lyme disease is left untreated or, in some rare cases, it can happen quickly after infection.

Shutterstock/5 second Studio

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Degrees Of Lyme Carditis

Like all other Lyme disease symptoms, they can be mild, moderate, or severe. Lyme literate doctors define these as first, second, or third degrees of Lyme carditis, with third-degree being the most severe.

With mild or first-degree Lyme carditis, electrical signals reach the hearts lower chambers, but they do so much slower than needed. With second-degree or moderate heart block, electrical signals reach the bottom chamber but not as much as they should.

Severe or third-degree heart block means electrical signals never reach the bottom chambers of the heart.

Anytime electrical signals cannot reach the hearts lower chambers, arrhythmias, and cardiac arrest can occur because the heart cannot beat normally.

Recognizing symptoms of all three degrees is crucial.

Systematic Approach For Lyme Carditis

Lyme Carditis: Why Early Diagnosis is Critical

To help healthcare providers consider Lyme carditis as a potential cause for heart block, our research team developed the Suspicious Index in Lyme Carditis score.

It allots points for specific risk factors. The resulting score classifies patients into low, intermediate, and high-risk categories for the likelihood that the heart block is due to Lyme carditis. The variables in the SILC score can be associated with the mnemonic CO-STAR: Constitutional symptoms, Outdoor activity/endemic area, Sex , Tick bite, Age , and Rash.

Table 1.The Suspicious Index in Lyme Carditis score evaluates the likelihood that a patients high-degree heart block is caused by Lyme carditis. The total score indicates low , intermediate , or high suspicion of Lyme carditis.

Variable
4

* fever, malaise, arthralgia, and dyspnea

Patients with high-degree heart block and a SILC score of three or higher should be investigated immediately for Lyme disease. They should also receive antibiotic treatment while awaiting the results of testing.

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Deterrence And Patient Education

If traveling to endemic areas, minimizing the contact with tick can be achieved by:

  • Wearing protective clothing
  • Repellent application to clothing
  • A thorough check and removal of ticks with the use of tweezers daily.

Antibiotic prophylaxis with oral doxycycline 200 mg is the recommended course for individuals with tick attachment for at least 36 hours.

Medical evaluation is necessary for people who develop a rash in the site of tick attachment, multiple skin lesions, or generalized flu-like symptoms.

How Lyme Carditis Affects The Heart

Lyme carditis most commonly manifests as high-degree atrioventricular block: a complete shut-down of the electrical system of the heart that can evolve rapidly over minutes, hours or days, producing severe symptoms like fainting, extreme dizziness or sudden death.

  • sinus node disease, marked by alterations to the hearts motor or natural pacemaker,
  • atrial fibrillation, which is a disorganization of the cardiac rhythm that increases the risk of stroke,
  • bundle branch blocks, or lesions in the distal cables of the heart that can interrupt electrical impulses, and
  • myocarditis, pericarditis or endocarditis, which are different degrees of inflammation of the layers of the cardiac walls.

Some of these manifestations can be so severe that total cardiac dysfunction may rapidly occur, and the patient may die despite medical efforts. Sometimes a heart transplant is the only option.

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Lyme Carditis: How Spirochetes Affect The Heart

In Lyme carditis, Borrelia burgdorferi directly affects the heart. Damage to the heart tissue occurs from the direct invasion by the bacteria, as well as from the bodys exaggerated immune response to the infection.

In 90% of cases, the most common consequence of Lyme carditis is heart block. Electrical signals from the upper chambers of the heart are not properly relayed to the lower chambers of the heart, which can dramatically slow down the heart rate.

The severity of the heart block can fluctuate rapidly and the progression to complete heart block can be fatal. Importantly, the heart block in Lyme carditis can be transient and usually resolves with antibiotic therapy. Additionally, Lyme carditis can affect other parts of the hearts conduction system, as well as the hearts muscle, valves, and outer layer of the heart wall.

What You Need To Know

Lyme Disease and Complete Heart Block: How Lyme Disease Can Affect The Heart

Lyme carditis occurs in up to 10% of cases of Lyme disease. The onset of symptoms is usually one to two months after the onset of infection. Cardiac symptoms may be the only manifestation of Lyme carditis, or someone may also experience Lyme diseases constitutional symptoms. Atrioventricular heart block is the most common Lyme carditis presentation and can cause lightheadedness, chest pain, shortness of breath, palpitations, and rarely death.

Lyme carditis should be suspected in anyone with a sudden onset of cardiac symptoms, mainly if they engaged in an outdoor activity one to two months before the onset of symptoms. Lyme carditis occurs more commonly in men under 50 years-old. A rash associated with Lyme disease can present with different characteristics than a bullseye rash. If a conduction disorder is diagnosed, physicians should immediately order a Lyme western blot test. Lyme carditis treated early with antibiotics can prevent the implantation of a permanent pacemaker and lead to a quick resolution of cardiac disease.

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Symptoms Of Lyme Carditis

It can take one to two months for the bacteria that causes Lyme disease to affect the heart and cause Lyme carditis symptoms. Common symptoms include:

  • Lightheadedness, dizziness

Although rare, Lyme carditis can be fatal if not diagnosed and treated promptly. Cardiac symptoms may be the only manifestation of Lyme disease, or a person may also experience other common Lyme disease symptoms such as pain, a rash, fevers, and neurological symptoms.

Case report: 16-year-old boy with Lyme carditis presenting with only palpitations Infectious disease doctors from the University of Minnesota report a case of a 16-year-old male with acute-onset palpitations and chest pain. Although the boy did not mention a rash on his leg and shoulder, the physicians discovered the rashes during an exam. An EKG detected an AV block. His blood count was normal, negative for a streptococcus infection, positive for Lyme disease, and negative for other tickborne infections. He was treated with intravenous ceftriaxone for ten days. When his EKG stabilized, he was discharged with a 28-day course of doxycycline. The authors concluded Lyme carditis in children has increased in the past two decades and suggest the importance of maintaining clinical suspicion in children with cardiac symptoms.

Enhancing Healthcare Team Outcomes

Patients with Lyme disease, in general, are managed by an interprofessional team because of its diverse presentation and difficulty in diagnosis. The majority of cases are manageable by the primary caregiver, nurse practitioner, and internist as part of an interprofessional team. However, Lyme carditis is best managed by an infectious disease expert and a cardiologist. While the condition usually resolves, close monitoring is necessary as some patients may require temporary pacing.

Lyme disease is best prevented. Primary care clinicians and nurses should work together to provide patient and family education in endemic areas.

Even though Lyme carditis occurs in only a small percentage of patients with Lyme disease, significant consequences can develop. Thus, people going to or living in endemic areas require education regarding protective measurements. Hikers should wear appropriate garments and know how to remove the tick.

If symptoms develop, immediate medical evaluation and assistance is a prudent course of action. Medical providers must have a high clinical suspicion of the disease taking into account epidemiological risk factors. If the suspicious index is high, further serologic testing is necessary for confirmation. Prompt treatment is required in established cases as the resolution rate is high if actions take place with no delay.

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Suspicious Index In Lyme Carditis

Lyme-literate cardiologist Adrian Baranchuk, MD, and colleagues developed a scoring system to evaluate the likelihood a patients AV block is caused by Lyme carditis. The Suspicious Index in Lyme Carditis score is based on 108 clinically relevant Lyme carditis cases from the medical literature. Six criteria that increased Lyme carditiss likelihood were extracted from the cases and given a weighted value. The mnemonic COSTAR is used for the following criteria with the clinical significance value in parenthesis:

  • Constitutional symptoms fever, fatigue, joint pain
  • Outdoor activity/endemic area
  • Age < 50 years old
  • Rash erythema migrans rash present

A high SILC score is 7-12, an intermediate SILC score is 3-6, and a low SILC score is 0-2. For example, a 15-year-old male , in northern California, who plays golf , has a rash on his leg and presents to the emergency room complaining of dizziness and shortness of breath would have a high SILC score. In addition to a standard cardiac workup, physicians should order a tickborne infection panel including Lyme disease.

Note, a rash caused by Lyme disease rarely presents as a stereotypical bullseye rash. Often the rash can be an oval-shaped and solid color. You can see images of a variety of Lyme disease rashes here.

Can Lyme Carditis Cause Tachycardia

Lyme carditis is potentially lethal manifestation of Lyme disease.What ...

Lyme bacteria can squirrel into all organs, tissues, and cells, and if it invades heart tissue, it can cause Lyme carditis, which can manifest in a number of ways: costochondritis, tachycardia, bradycardia , heart block (an electrical disconnect between the upper and lower chambers of the heart, …

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