Lyme Carditis May Be An Early Manifestation Of Lyme Disease
Lyme disease is a tick-borne bacterial infection with endemic regions predominantly along the CanadaUnited States border. In 2016, 987 cases of Lyme disease were reported in Canada.1 The heart is involved in up to 10% of Lyme disease cases, with the development of cardiac tissue inflammation or Lyme carditis.2 Nearly all patients with Lyme carditis will have atrioventricular block,3 which commonly presents with breathlessness, palpitations, dizziness or syncope.2
Can Someone Whos Been Treated For Lyme Disease Still Have Symptoms
Physicians usually prescribe Lyme patients with a two to four week course of oral antibiotics. This resolves the majority of cases, says Eugene Shapiro, MD, a professor of pediatrics and epidemiology at Yale University.
However, PTLDS manifests when patient experience persistent symptoms despite undergoing treatment. Because traces of the bacteria rapidly disappear from an individuals blood, testing for residual post-treatment infection is challenging, says Monica Embers, PhD, director of vector-borne disease research at Tulane Universitys National Primate Research Center.
When patients face possible post-treatment complications, tests cant indicate whether these symptoms are driven by Lyme versus something else entirely. According to Embers, current antibody tests are only about 50% to 60% accurate, but they grow more sensitive four or more weeks after the initial infection as people further develop antibodies.
Whats desperately needed is a diagnostic test that can be used in chronic patients to demonstrate that they have had Lyme disease or continue to have a persistent infection, and we dont have that right now, says Embers.
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Touched By Lyme: When Lyme Disease Affects The Heart
Gone in a Heartbeat: A Physicians Search for True Healing, by Neil Spector, MD.
Neil Spector was a seemingly healthy physician living with his wife in Florida. One day, he experienced what appeared to be textbook symptoms of a heart attack. Erratic heartbeat, chest pressure, pain radiating from chest to neck and jaw. Except all the tests the emergency room gave him turned out normal. He wasnt having a heart attack, his doctors said. They chalked it all up to stress, suggested he learn how to relax, and sent him on his way.
Spector continued to have troubling symptoms. Often, his heart pounded too fast. Other times, way too slowly. Sometimes, without warning, hed fall to the ground. He had extended periods of bradycardia, when the heart doesnt pump enough oxygen-rich blood throughout the body. Yet, the answer from doctors was always the same: Nothing wrong at all. Just a little stress.
Gone in a Heartbeat: A Physicians Search for True Healing, Spectors gripping memoir, covers about two decades. It starts with those initial heart-related episodes. Then it progresses to stages where he needs a pacemaker, then an internal defibrillator, and eventually a heart transplant. Its a riveting account of how this affects him, his wife, and their family. Its also about Lyme disease.
Several weeks after receiving a pacemaker, Spector develops arthritis in his wrists. Coincidentally, he takes doxycycline for something unrelated. To his surprise, his wrist pain goes away.
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Duration Of Lyme Disease Treatment
Duration of treatment is measured by clinical response. The duration of treatment is usually shorter, such as 5-7 days in a child under seven as opposed to a longer-term treatment .
The criteria used for the cessation of antibiotic therapy is if a child can: 1) be Lyme symptom-free for two months 2) not have a Lyme-induced flare-up as a result of another infection, fatigue, emotional trauma or injury 3) can show a Western blot that does not reflect active infection and 4) is PCR negative. If a particular medicine is working and is well tolerated, continue it until the above criteria are met.
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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When Should You See A Doctor If You Think You Have Lyme
The rash is a pretty good indication that you may have been bitten. Take a photo of the rash and see your doctor. At this stage, treatment with antibiotics will probably work.
If you dont have the rash but have symptoms like fatigue, fever, and headache but no respiratory symptoms like a cough, you may want to talk to your doctor.
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What Does Lyme Disease Do To A Child
One aspect of Lyme in the young children is the emotional component they suffer. They are inexperienced with handling severe difficulties in their lives. Children often get trapped into believing that they will be ill or in pain all of their lives.
Many with the onset of Lyme early in their lives have never experienced freedom from pain or disease. One child came into the office after treatment was complete and began saying I didnt know anybody could feel like this. I didnt know my body didnt have to hurt.
Older children have more reserves and life experiences to draw upon. They often know that this is a temporary setback and that they can get well again. The remarkable aspect of treating Lyme disease in children is that most get better and many get well, without carrying the stigma of Lyme disease or its co-infections.
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Living With Heart Block
Follow your healthcare providers recommendations for taking medicine and using a pacemaker, if that applies to you. Also, always keep follow-up appointments to make sure your treatment is on track.
To improve your quality of life with a pacemaker, you may need to:
- Avoid situations in which your pacemaker may be disrupted, such as being near an electrical device or devices with strong magnetic fields.
- Carry a card that lets people know what kind of pacemaker you have.
- Tell all of your healthcare providers that you have a pacemaker.
- Get routine pacemaker checks to make sure your device is working well
- Stay active, but avoid contact sports.
- Wear a medical alert bracelet or necklace.
Considerations While On Lyme Treatment
Antibiotics can wipe out beneficial intestinal flora, leading to a wide variety of additional health problems. It is important to take probiotics while on antibiotics to maintain a healthy balance of gut bacteria. Furthermore, antibiotics may interact with other drugs, supplements or food. The National Institutes of Healths MedLinePlus website gives information about drug interactions.
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Antimicrobials That Kill Growing Phase Cysts
Intracellular and Extracellular
Note: I work with the following agents as anti-cyst agents based on the mechanism by which these antibiotics work and some scientific experiments. For the Rifamycins, there are no laboratory experiments showing these agents work against cysts. Clinically, I see great benefit in using the Rifamycins as my anti-cyst agents so I list them here.
Rifamycins
- Rifampin 300 mg 2 pills 1 time a day or 1 pill 2 times a day
- Rifabutin 150 mg 2 pills 1 time a day
Azoles
- Tinidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days
- Metronidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days.
Herbal
- Grapefruit seed extract 250 mg 1 pill 2 times a day. Note this is an herbal antibiotic that I find as effective as the prescription options in this list.
Lyme Carditis: Heart Block And Other Complications Of Lyme Disease
The incidence of Lyme disease, a tick-borne bacterial infection, is rapidly increasing in North America. Risk modeling suggests that the incidence of Lyme disease will continue to rise as the migratory birds that are responsible for transmitting the Ixodes tick are affected by climate change and consequently, contribute to the expansion of at-risk regions. Lyme disease can affect many organ systems, including the heart, nerves, and joints.
In this article, the authors intend to highlight one of the most dramatic complications of Lyme disease, early dissemination Lyme carditis.
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Tetracycline Plus Macrolide Plus Grapefruit Seed Extract Plus Japanese Knotweed
- doxycycline 100 mg 2 pills 2 times a day
- clarithromycin 500 mg 1 pill 2 times a day
- grapefruit seed extract 250 mg 1 pill 2 times a day.
- Japanese knotweed½ tsp 3 times a day
Key Points:
- Tetracyclines and macrolides both block protein production by binding to the protein production apparatus in germs called ribosomes. But they each bind to a different part of the ribosome improving the blockade of protein production.
- Japanese knotweed is added here to treat persister Lyme. It also may treat growing Lyme and can lower inflammation cytokines.
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Common Conditions Requiring Medication Treatment For Lyme Disease
Lyme disease requires medication treatment. If you dont take proper medication, your condition can get much worse. It is important to continue seeing your doctor, even if you are feeling better, until your doctor says you are free of the disease. Be sure to share if you are getting new symptoms or have found your symptoms are not improving.
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What Causes Heart Block
If you are born with heart block, you have congenital heart block. Either a condition your mother had during her pregnancy, or heart problems you were born with, cause this condition.
For most, heart block develops as you get older as the wires that connect the top and bottom of the heart can develop fibrosis and eventually fail. Sometimes this may happen due to advancing age. Any process which can damage these heart wires can result in heart block. Coronary artery disease with and without a heart attack is one of the most common causes of heart block. Cardiomyopathies which are diseases that weaken the heart muscle can also result in wire damage. Any disease that can infiltrate the heart such as sarcoidosis and certain cancers or any disease that results in heart inflammation such as certain autoimmune disease or infections can result in heart block. Electrolyte abnormalities especially high potassium levels can also result in wire failure.
Macrolide Plus Grapefruit Seed Extract Plus Cryptolepis
- clarithromycin 500 mg 1 pill 2 times a day
- grapefruit seed extract 250 mg 1 pill 2 times a day.
- cryptolepis 5 ml 3 times a day
Key Points:
- Grapefruit seed extract is better tolerated than both tinidazole and metronidazole and supports killing of Lyme cysts.
- Cryptolepis can treat persister and growing Lyme. If a person also has Babesia, cryptolepis can treat this too.
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Lyme Carditis And Erythema Migrans
Lyme disease and Lyme carditis are often misdiagnosed due to their rarity and variable presentation. Patients report seeking medical attention numerous times before the correct diagnosis is made. For localized Lyme disease , only 40% to 80% of patients develop EM. It is important to note that EM typically appears within 7 to 14 days after the tick bite, and should be differentiated from the initial erythematous or blistering allergic skin reaction at the site of the bite. For example, EM will continue to enlarge in the first few days after its appearance, whereas an insect bite reaction will decrease in size. Furthermore, the EM lesion does not always manifest as the typical annular lesion with a central clearing. It can also manifest as an erythematous lesion without a central clearing, or with multiple rings around it, or with a central violaceous area. Indeed, in an observational cohort study of 118 cases, central clearing was seen in only 9% of cases homogeneous lesions and central erythema were observed in 59% and 32% of patients, respectively. This can make recognition of EM, and by extension, diagnosis of Lyme disease, difficult. As such, the cutaneous manifestations of Lyme disease are sometimes misdiagnosed as more common dermatologic diseases.
Importance Of Prompt Recognition And Treatment Of Lyme Carditis
The standard protocol for high-degree heart block calls for implanting a permanent pacemaker. However, the heart block in Lyme carditis will most likely resolve with antibiotic therapy. Thus, identifying Lyme carditis as the underlying cause of the heart block can prevent the unnecessary implantation of permanent pacemakers.
The battery of a pacemaker lasts 7-10 years. Thus, a missed diagnosis could subject an otherwise young, healthy patient to 5-7 battery replacements over a lifetimewith each procedure bringing potential adverse events. These risks associated with the initial pacemaker implantation can be mitigated by intravenous and oral antibiotic treatment for heart block caused by Lyme carditis.
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Stage : Early Localized Disease
Symptoms of Lyme disease usually start 1 to 2 weeks after the tick bite. One of the earliest signs of the disease is a bulls-eye rash.
The rash occurs at the site of the tick bite, usually, but not always, as a central red spot surrounded by a clear spot with an area of redness at the edge. It may be warm to the touch, but it isnt painful and doesnt itch. This rash will gradually fade in most people.
The formal name for this rash is erythema migrans. Erythema migrans is said to be characteristic of Lyme disease. However, many people dont have this symptom.
Some people have a rash thats solid red, while people with dark complexions may have a rash that resembles a bruise.
The rash can occur with or without systemic viral or flu-like symptoms.
Other symptoms commonly seen in this stage of Lyme disease include:
Before Considering Implantation Of A Permanent Pacemaker Clinicians Should Wait For Response To Antibiotic Treatment For Atrioventricular Block Requiring Temporary Pacing
High-degree atrioventricular block usually resolves within one week of starting antibiotics. Figure 1A shows the reversal of conduction abnormality after treatment with antibiotics. A predischarge exercise stress test to assess atrioventricular conduction during higher heart rates is useful in guiding decisions regarding cardiac pacing.3
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Cardiologists: Know The Signs Of Lyme Disease
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Spring has arrived, and along with warmer weather and blossoming tree buds, a seasonal risk looms, especially for outdoor enthusiasts. The risk for Lyme disease, and the cardiac complications that can be associated with it, increases as people spend more time outdoors.
Lyme disease is an infection caused by a species in the spirochete pathogen Borrelia burgdorferi sensu lato group and is spread through tick bites.
Lyme disease is often overlooked by physicians, but its important to recognize and treat because of the cardiac complications that can occur if left untreated. Every cardiologist should be able to recognize signs and symptoms,Nieca Goldberg, MD, cardiologist in the department of medicine, Leon H. Charney division of cardiology, and director of the Joan H. Tisch Center for Womens Health at NYU Langone Medical Center, told Cardiology Today.
Nieca Goldberg
Often, the first sign is a rash at the site, known as a bulls-eye rash with a red ring and red center, Goldberg said.
According to the CDC, the rash is usually not painful or itchy, so it may be overlooked.
In the early localized stage, symptoms can include a rash, fatigue, chills, fever, headache, swollen lymph nodes and joint aches, similar to symptoms for many other diseases, including influenza or a common cold.
Disclosure: Goldberg reports no relevant financial disclosures.
Controversy: Split Over Treatment For Persistent Symptoms
Medical groups continue to disagree about the optimal approach if a patients symptoms persist after the initial antibiotic treatment. A recent Lyme disease overview summarizes the differing guidelines .
- When patients have persistent or recurrent symptoms following recommended antibiotic treatment but no evidence of reinfection, further treatment is not recommended .
- While other potential causes for persistent symptoms should be investigated first, additional antibiotics are recommended if a chronic Lyme infection is believed to be a possible cause for ongoing symptoms and the patient has an impaired quality of life .
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Advanced Treatment Of Lyme Disease
Lyme-literate doctors are often researchers and contributors to international societies on Lyme disease. They have the most up-to-date information and opportunities for treating Lyme disease, including Lyme carditis.
Therapeutic apheresis has a success rate in helping people feel better shortly after treatment. Apheresis can be done with blood or plasma. It is the process of removing infected, unhealthy blood or plasma from your body and replacing it with healthy, donated blood or plasma.
Intravenous therapies provide your body with antibiotics and immune-boosting nutrients. Rather than give you oral antibiotics or vitamins that get broken down while traveling through the digestive system, your doctor can administer them directly into your bloodstream. The antibiotics begin immediately fighting Lyme bacteria where they live.
IV therapies can also be used with anti-parasitic and anti-viral protocols combined with detox methods that can flush the Lyme bacteria from your system. For the more stubborn bacteria, the ones that hide from antibiotics, it may be necessary to use biofilm eradication protocols. Antimicrobials break down the walls protecting bacteria, so elimination is successful.