Lyme disease heart complications can occur in some patients and are usually referred to as Lyme carditis due to the inflammatory nature of the condition. Lyme carditis is usually fully resolvable when treated quickly and appropriately and may occur in those with no pre-existing heart problems. The symptoms of Lyme carditis can be extremely worrying and scary for sufferers with palpitations, slowing of the heart, breathlessness, throbbing in the neck, dizziness or faintness, fatigue, and difficulty breathing when lying down or sleeping. Patients with pre-existing heart problems may not bring any exacerbation of symptoms or new symptom development to the attention of their physician which can allow Lyme disease to masquerade as worsening heart disease and remain untreated.
One of the potential causes of the problems associated with Lyme carditis is that the Borrelia bacteria disrupt the electrical signalling that occurs in the heart, leading to what is called an atrioventricular heart block. This prevents the proper signalling between the upper and lower chambers of the heart and adversely affects the carefully regulated filling and emptying of these chambers with blood. It is thought that around 10% of people with Lyme disease develop some degree of Lyme carditis but this is often allowed to continue as physicians fail to recognize the symptoms in those with other cardiovascular problems.
Lyme disease antibiotic treatment is usually sufficient to clear Lyme carditis, with a four-week course of doxycycline very effective for mild cases. Where severe atrioventricular heart block is present intravenous antibiotics may be needed and the patient monitored in hospital during treatment. Around 30% of patients may require a temporary or pacemaker to regulate the heart’s electrical activity; permanent pacemakers are less likely to be needed.
Some patients will have Lyme carditis and remain largely asymptomatic, with the condition simply resolving as they are successfully treated with antibiotics for Lyme disease. In rare instances a patient may have fatal Lyme carditis which is not diagnosed or treated in time. There are some reports of autopsies finding evidence of infection with Borrelia in patients who have died from heart failure, although patients dying from other causes, unrelated to Lyme disease, have also shown evidence of Borrelia spirochaetes in their heart tissue.
Diagnosing Lyme Disease Heart Problems
Diagnosis is usually made through assessment of clinical features of borreliosis in the patient, their medical history and history of tick bites, and the use of an electrocardiogram along with investigation of chest pain, palpitations, syncope, and dyspnea. In some patients acute myopericarditis may occur where the muscle of the heart wall and the pericardium (the protective sack around the heart) become inflamed. Cardiomegaly (enlargement of the heart) has also been observed in some patients with Lyme disease, although this does appear to be rare.
The development of Lyme disease heart problems usually occurs following erythema migrans, and in tandem with meningoencephalitis, facial palsy, neck pain, and Lyme arthritis. Lyme carditis may only cause brief symptoms for a few days, or can last for several weeks. The symptoms may become worse at the onset of Lyme disease antibiotic treatment as the bacterial die-off begins but this Lyme disease treatment symptom should resolve within a day or so of treatment for most patients.
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