posted
Cardiac manifestations of Lyme disease: a review.
Nagi KS, Joshi R, Thakur RK.
Arrhythmia Service, University Hospital, London, Ontario.
OBJECTIVE: To describe the clinical features of cardiac manifestations of Lyme disease, the most common vector-borne illness in North America, which occasionally results in cardiac involvement.
DATA SOURCES: A review of the English-language clinical literature pertaining to Lyme disease and Lyme carditis indexed in MEDLINE from 1975 to 1995. DATA EXTRACTION: Studies describing diagnosis, clinical features, treatment or outcome were reviewed.
DATA SYNTHESIS: Cardiac complications of Lyme disease may occur in up to 8% of patients. Cardiac manifestations occur in the early phase of the illness, at a median of 21 days from the onset of erythema migrans. Manifestations of Lyme carditis include atrioventricular block, myopericarditis, intraventricular conduction disturbances, bundle branch block and congestive heart failure.
Temporary cardiac pacing may be required in up to a third of cases and complete recovery occurs in most {greater than 90%} patients. The overall prognosis of Lyme carditis is very good, although recovery may be delayed and late complications such as dilated cardiomyopathy may occur.
CONCLUSION: Lyme disease is a tick-borne spirochetal infection caused by Borrelia burgdorferi. Cardiac complications of Lyme disease generally occur in the early phase and include conduction system disturbances, myopericarditis and congestive heart failure.
Can J Cardiol. 1996 May;12{5}:503-6.
***** Cardiac manifestations of Lyme disease.
Pinto DS.
Harvard Medical School, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. [email protected]
Lyme disease is a vector-borne illness that can affect numerous organ systems during the early disseminated phase, including the heart. The clinical course of Lyme carditis is usually benign with most patients recovering completely.
Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement can occur but generally is mild and self-limited.
Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, EM, or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea.
Serologic studies and endomyocardial biopsy can support the diagnosis in the correct clinical setting, and MR imaging, echocardiography, and gallium scanning have utility in selected circumstances. No treatment has been shown clearly to attenuate or prevent the development of Lyme carditis, but mild carditis generally is treated with oral antibiotics and severe carditis with intravenous antibiotics in an effort to eradicate the infection and prevent late complications of Lyme disease.
There is conflicting evidence regarding the role that B. burgdorferi plays in the development and progression of chronic congestive heart failure. Because of the significant false-positive ELISA rate in this population and the unclear benefit of antibiotic therapy, confirmatory Western blot analysis is recommended.
Routine therapy and screening of patients with idiopathic dilated cardiomyopathy is of limited utility and should be reserved for patients with clear history of antecedent Lyme disease or tick bite.
Med Clin North Am. 2002 Mar;86{2}:285-96.
****** Cardiovascular manifestations of Lyme disease.
Cox J, Krajden M.
Department of Microbiology, Toronto General Hospital, Ontario, Canada.
Although the cardiac manifestations of Lyme disease may be diverse, in general they are treatable with currently available therapies.
A high index of suspicion is required to make a diagnosis, especially for patients who may lack a suggestive history of tick exposure or residence in an endemic region. Lyme disease-related heart block may require pacemaker insertion and supportive care.
-------------------- nan Posts: 2135 | From Tick Country | Registered: Oct 2000
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timaca
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The first article made me chuckle, for it talked about cardiac manifestations ocurring 21 days after EM.
21 days after the steriod shot to my knee I started to get weird symptoms...it was 23 days after the steroid shot that I had extended tachycardia...and ended up in the cardiologist's office. He didn't think of lyme.
My hubby has some heart stuff going on (Atrial fib and dialated cardiomyopathy). Because of my history (and the fact that our cardiologist has learned a lot about lyme), my hubby was tested for lyme (with suspicious tests but not CDC diagnostic). He is being treated with antibiotics. We hope this helps his heart.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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After spending an afternoon in the ER with atrial fibrillation that would not stop, I started back on abx after a none month hiatus.
After a week of abx I have noticed a huge improvement.
Have to see a cardiologist tomorrow morning and I hope he will be open to the suggestion that Lyme is the culprit.
-------------------- nan Posts: 2135 | From Tick Country | Registered: Oct 2000
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klutzo
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Member # 5701
posted
It seems to me, after reading on this forum for about 3 years, that carditis and/or heart block are not the major heart problems for most of us.
From my own experience and from what I've read here, various forms of arryhthmia, especially the tachycardias, are a problem for a lot of us, not just the meager 8% quoted in the article.
I myself have: 1) occassional atrial fibrillation, 2) Lyme panic attacks (the kind that last 1 1/2 hours instead of 1 1/2 minutes),and 3)Paroxysmal Supraventricular tachycardia, which is the one symptom of Lyme that has most limited my life.
It seems like a lot of us have Postural Orthostatic Tachycardia Syndrome. My systolic blood pressure drops 30 points when I stand up, so I would have that one too, if it were not for my high blood pressure. I do not become faint or develop rapid heartbeat when I stand up, like those with POTS, because my pressure is dropping from too high to normal. (Who knew high blood pressure could be good for something!).
Just about every article I read on Lyme makes it sound as if heart problems are rare, even some by the "good guys". I wonder why that is.....
Klutzo
Posts: 1269 | From Clearwater, Florida, USA | Registered: May 2004
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lou4656
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Member # 10300
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I am being so thankful right now after reading the cardiac posts. I am going to a cardiologist today for the results of a nuclear stress test.
My doc (not an LLMD, but one who has done his studying on Lyme and is treating me with long term abx) brought a local cardiologist to my last follow-up appt. He explained alot about lyme to the cardiologist, and I even learned a few things in the process.
So -- I am assuming there will be no eye rolling today when I see the cardiologist for my results.
And if the results are good, I will be back on the treadmill in an effort to get rid of the 25 lbs. that I have put on since I got sick in October.
-------------------- LouLou Posts: 1276 | From maryland | Registered: Oct 2006
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treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
Thanks for the post
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
Heres a 100 articals.
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34: Paparone PW. Cardiovascular manifestations of Lyme disease. J Am Osteopath Assoc. 1997 Mar;97(3):156-61. Review. PMID: 9107126 [PubMed - indexed for MEDLINE]
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36: Morphet J. Cardiac manifestations of Lyme disease. Can J Cardiol. 1996 Nov;12(11):1146. No abstract available. PMID: 9191506 [PubMed - indexed for MEDLINE]
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38: Flisiak R, Prokopowicz D. [Epidemiologic and clinical characteristics of Lyme borreliosis in northeastern Poland] Pol Tyg Lek. 1996 Jun;51(23-26):326-8, 330. Polish. PMID: 9273521 [PubMed - indexed for MEDLINE]
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80: Park M. Ocular manifestations of Lyme disease. J Am Optom Assoc. 1989 Apr;60(4):284-9. PMID: 2723324 [PubMed - indexed for MEDLINE]
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89: Lorcerie B, Boutron MC, Portier H, Beuriat P, Ravisy J, Martin F. [Pericardial manifestations of Lyme disease] Ann Med Interne (Paris). 1987;138(8):601-3. French. PMID: 3450205 [PubMed - indexed for MEDLINE]
90: Asbrink E, Olsson I, Hovmark A. Erythema chronicum migrans Afzelius in Sweden. A study on 231 patients. Zentralbl Bakteriol Mikrobiol Hyg [A]. 1986 Dec;263(1-2):229-36. PMID: 3577482 [PubMed - indexed for MEDLINE]
91: Weber K, Neubert U. Clinical features of early erythema migrans disease and related disorders. Zentralbl Bakteriol Mikrobiol Hyg [A]. 1986 Dec;263(1-2):209-28. PMID: 3577481 [PubMed - indexed for MEDLINE]
92: Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Pachner AR, Rahn DW, Sigal LH, Taylor E, Malawista SE. Clinical manifestations of Lyme disease. Zentralbl Bakteriol Mikrobiol Hyg [A]. 1986 Dec;263(1-2):201-5. Review. PMID: 3554839 [PubMed - indexed for MEDLINE]
93: Olson LJ, Okafor EC, Clements IP. Cardiac involvement in Lyme disease: manifestations and management. Mayo Clin Proc. 1986 Sep;61(9):745-9. PMID: 3747616 [PubMed - indexed for MEDLINE]
94: Kapusta P, Fauchier JP, Cosnay P, Huguet R, Grezard O, Rouesnel P. [Sinoatrial and atrioventricular conduction disorders in Lyme disease. Apropos of 2 case reports] Arch Mal Coeur Vaiss. 1986 Aug;79(9):1361-6. French. PMID: 3101641 [PubMed - indexed for MEDLINE]
95: Allal J, Coisne D, Thomas P, Vieyres C, Gallimard JF, Becq-Giraudon B, Foullon P, Barraine R. [Cardiac manifestations of Lyme disease] Ann Med Interne (Paris). 1986;137(5):372-4. French. PMID: 3813267 [PubMed - indexed for MEDLINE]
96: Weber K, Schierz G, Wilske B, Preac-Mursic V. [Clinical aspects and etiology of acrodermatitis chronica atrophicans] Hautarzt. 1984 Nov;35(11):571-7. German. PMID: 6394553 [PubMed - indexed for MEDLINE]
97: Cornuau C, Bernard M, Daumas PL, Oblet B, Poirot G, Valois M. [Cardiac manifestations of Lyme disease. Apropos of 2 cases] Ann Cardiol Angeiol (Paris). 1984 Oct;33(6):395-9. French. PMID: 6497303 [PubMed - indexed for MEDLINE]
98: Weber K, Puzik A, Becker T. [Erythema migrans disease. A contribution to its clinical features and relation to Lyme disease] Dtsch Med Wochenschr. 1983 Aug 5;108(31-32):1182-90. German. PMID: 6872871 [PubMed - indexed for MEDLINE]
99: Pegram PS Jr, Sessler CN, London WL. Lyme disease in North Carolina. South Med J. 1983 Jun;76(6):740-2. PMID: 6857306 [PubMed - indexed for MEDLINE]
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All on lyme and the heart
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
posted
I did see the cardiologist and his eyes did not glaze over when I mentioned my chronic lyme. He listened carefully, taking notes. Said he didn't know much about lyme. (do any of them?)
Then he agreed that it was probably a flare in the lyme that brought it on, and since I had seen improvement back on abx he would order a nuclear stress test and echocardiogram.
I was tempted to pull out the articles I posted at the top for him to read....decided not to push my luck.
-------------------- nan Posts: 2135 | From Tick Country | Registered: Oct 2000
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randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
I don't know what the medical term for it is, but I have what I call "irregular heartbeats."
My heart rhythm goes along fine, then whump, beats very fast, I get short of breath, and feel like someone is squeeshing my chest together. It feels like my heart is going to burst out of my chest.
Scares me to death...Is there a term for this??
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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klutzo
Frequent Contributor (1K+ posts)
Member # 5701
posted
Dear Randibear, Please go to a Cardiologist and get a Cardiac Event Monitor (do not accept a Holter Monitor.....they are not nearly as good!). They are covered by every insurance I know of.
It could be many things. You need to find out what this is. The Event Monitor is a very small device, and you can wear it for up to a month, until your problem occurs. When it happens, you push a button to record it, then play it over the phone to a center that is staffed 24 hrs. per day. If it is abnormal they call the heart doc right away.
I had strange heart symptoms too, and it took 12 years of suffering and 2 negative Holters before I finally got a Cardiac Event Monitor. After only one night, I had my answer, and am on a drug that helps control it now.
Good luck, Klutzo
Posts: 1269 | From Clearwater, Florida, USA | Registered: May 2004
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posted
Your pose some interesting questions, Joe. *In my case, I was pretty surprised ro find myself in the ER with atrial fibrillation after 14 years of on and off treatment.
Am sure you are correct about the 8%..I think that should be higher. I know lots of lymeies who complain about tachycardia and other heart-related problems!
Cheers...and thanks for the article!
-------------------- nan Posts: 2135 | From Tick Country | Registered: Oct 2000
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today when I see the cardiologist for my results.![[Big Grin]](biggrin.gif)
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