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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.
-- When the weather is warm, working outdoors or walking in the woods may net you a tiny, blood-sucking hitchhiker - a tick that could carry Lyme disease. And the spiral-shaped bacteria that cause Lyme disease sometimes head for the heart, where they trigger problems that often masquerade as new or worsening heart disease. The August issue of the Harvard Heart Letter tells you how to spot trouble and prevent contact with ticks. Lyme carditis is the heart infection caused by Lyme disease.
The bacteria that cause Lyme carditis disrupt the heart's pattern of electrical activity, delaying or blocking electrical signals that travel between the upper and lower chambers of the heart. This infection affects only 1 in 10 people who get Lyme disease, but its symptoms are often mistaken for other cardiac problems and can result in misdiagnosis.
The Harvard Heart Letter tells you what symptoms to look out for and what Lyme carditis treatment options are available:
Symptoms * Dizziness or fainting * Shortness of breath * Heart palpitations * Fatigue * Trouble breathing when lying down or sleeping * A throbbing sensation in the neck
Source: The Harvard Heart Letter (http://www.health.harvard.edu) Treatment
* Four weeks of the oral antibiotic doxycycline will usually clear up mild cases of Lyme carditis. * Intravenous antibiotics may be needed for more serious problems such as heart block. * A small percentage of patients require temporary or permanent pacemakers to stabilize their heart's electrical activity. Source: The Harvard Heart Letter (http://www.health.harvard.edu)
The Harvard Heart Letter also offers tips to help avoid ticks and Lyme carditis:
* If you're going into tick territory, wear bright-colored clothes that make it easier to spot dark-colored ticks. * Make barriers by tucking your socks into your pants and wearing a long-sleeved shirt. * Use an insect repellent that contains DEET on your skin and clothes. * Before you go to bed, check yourself for ticks - if you find one, use tweezers to gently but firmly pull it off. Source: Harvard Heart Letter (http://www.health.harvard.edu)
Harvard Heart Letter is available from Harvard Health Publications, the publishing division of the Harvard Medical School. You can subscribe to Harvard Heart Letter for $32 per year at http://www.health.harvard.edu or by calling 1-877-649-9457 toll-free.
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
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