Reported cases of Lyme disease in the US are around 30,000 per year but there are estimated to be around 8-10 times that many cases in total as many are unreported. New statistics show that around 1% of patients diagnosed with Lyme disease experience reported atrioventricular block, a heart complication, but with so many unacknowledged cases of Lyme disease in America are there actually many more people out there with Lyme carditis who have been misdiagnosed?
Lyme carditis is considered a rare complication of infection with Borrelia burgdorferi, which may primarily affect those with an increased susceptibility to heart problems, although this hasn’t been confirmed. Indeed, a recent trio of fatal cases in younger patients with no earlier signs of problems has the medical profession reassessing perception of this Lyme disease complication.
The signs and symptoms of Lyme disease and carditis were missed in these patients who were aged 26-38. Either the patients did not seek medical attention for symptoms such as muscle pain and malaise, or their symptoms such as breathlessness and anxiety were not linked to Lyme disease. All of the patients were found to be in the early stage of disseminated Lyme disease.
Symptoms of Lyme Carditis
Carditis literally means inflammation (-itis) of the heart (cardiac) tissue, and in Lyme carditis this inflammation may occur in the endocardium, myocardium, epicardium, and pericardium all at the same time, i.e. a pancarditis that can affect all parts of the heart. Symptoms of Lyme carditis and Lyme disease in general may include:
- Chest palpitations and pain
- Muscle aches and pains
- Erythema migrans (the Lyme disease rash)
- Neurological or cognitive abnormalities (such as confusion and poor concentration).
The most common sign of Lyme carditis is atrioventricular block, thought to affect 1 in 100 Lyme disease cases, according to records from the US Centers for Disease Control. Atrioventricular block may be first-, second-, or third-degree block and it is this that is tied to the first three symptoms in the list above. These heart problems do not typically arise immediately after Lyme disease develops but may result some weeks or even months after infection.
Diagnosing Lyme Carditis
Patients who develop atrioventricular block are not always suffering from other Lyme disease symptoms at the time and may find it difficult to recall such symptoms, making it difficult for a physician to correctly diagnose the cause of the problem. As such, it is not always the case that patients will be tested for Lyme disease and started on antibiotic therapy, although this therapy is usually sufficient to eradicate the infection and remove the cause of the heart inflammation.
Treating Lyme Carditis
Lyme carditis that takes some time to diagnose may cause heart tissue damage that then takes even longer from which to heal. Patients may require hospitalization and the fitting of a temporary pacemaker to regulate the heartbeat. After antibiotic treatment is commenced heart symptoms are usually resolved within 1-6 weeks and death is rare, although it is also unlikely that those with existing heart problems will be tested for the presence of Lyme disease bacteria in diseased heart tissue upon death.
Following these recent deaths, it is important to note that males appear to be more likely to develop Lyme carditis, as do those aged 15-45 compared to the frequency of Lyme disease cases as a whole. Most cases arise in the summer or early fall, and only around 40% of those with the heart complication of Lyme disease report having the rash, a lower proportion than overall Lyme cases which put erythema migrans incidence at 70-80% of reported cases.
Cutting Lyme Carditis Cases
Anyone experiencing symptoms of Lyme disease should report cardiac symptoms to their physician and undergo appropriate testing, while those with atrioventricular block that has no clear explanation should be asked about tick exposure and other symptoms, especially in states where Lyme disease is common. Most of all, those living in such Lyme-endemic areas should practice tick bite prevention and learn how to spot Lyme symptoms early so as to quickly access treatment should Lyme carditis occur.