Lyme Disease and the heart

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
Post Reply
User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:37

1: Przegl Epidemiol. 2004;58(4):589-96. Links
[Cardiac manifestations of Lyme borreliosis][Article in Polish]
Grzesik P, Oczko-Grzesik B, Kepa L.
Katedra i Klinika Chorob Wewnetrznych, Angiologii i Medycyny Fizykalnej w Bytomiu Sla,skiej Akademii Medycznej w Katowicach.

Lyme borreliosis is increasing in Poland in both incidence and recognition with 655 cases reported in 1997 and 3574 in 2003. Approximately 4% of patients will develop cardiac manifestations--the least well documented complication of Lyme disease. Cardiac involvement usually occurs within weeks to months of the infecting tick bite and includes varying degrees of atrioventricular block as the commonest manifestation and tachyarrhythmias, myopericarditis, mild cardiac muscle dysfunction. There has been evidence that long standing dilated cardiomyopathy may be associated with chronic Borrelia burgdorferi infection. Patients with atrioventricular block have good prognosis. Most cases resolve within 1 to 2 weeks. Temporary, but almost never permanent, cardiac pacing may be required for some patients. Cardiac manifestations of Lyme disease are treatable with antibiotics. Lyme carditis should be taken into consideration in patients with acute as well as chronic heart diseases.

PMID: 15810500

J Invasive Cardiol. 2003 Jun;15(6):367-9. Links
Complete heart block due to lyme carditis.Lo R, Menzies DJ, Archer H, Cohen TJ.
Section of Electrophysiology in the Division of Cardiology, Department of Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA.

Lyme carditis is becoming a more frequent complication of Lyme disease, primarily due to the increasing incidence of this disease in the United States. Cardiovascular manifestations of Lyme disease often occur within 21 days of exposure and include fluctuating degrees of atrioventricular (AV) block, acute myopericarditis or mild left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis. AV block can vary from first-, second-, third-degree heart block, to junctional rhythm and asystolic pauses. Patients with suspected or known Lyme disease presenting with cardiac symptoms, or patients in an endemic area presenting with cardiac symptoms with no other cardiac risk factors should have a screening electrocardiogram along with Lyme titers. We present a case of third-degree AV block due to Lyme carditis, illustrating one of the cardiac complications of Lyme disease. This disease is usually self-limiting when treated appropriately with antibiotics, and does not require permanent cardiac pacing.

PMID: 12777681

Hellenic J Cardiol. 2006 Sep-Oct;47(5):313-6. Links
Lyme carditis: complete atrioventricular dissociation with need for temporary pacing.Xanthos T, Lelovas P, Kantsos H, Dontas I, Perrea D, Kouskouni E.
Department of Experimental Surgery and Surgical Research, Aretaieion Hospital, University of Athens Medical School, Greece. theodorosxanthos@yahoo.com

Lyme borreliosis is a tick-borne disease. Cardiac manifestations of the disease are extremely rare. We report a case of Lyme carditis in an otherwise healthy male, who presented to the Accident & Emergency Department with chest pain, dizziness and generally symptoms indicating ischaemic heart disease. This patient, without documented history of Lyme disease, acutely developed third-degree atrioventricular block, which required placement of a transvenous pacemaker and resolved when the patient was administered doxycycline.

PMID: 17134068

: Int J Cardiol. 2007 Feb 14;115(3):e108-10. Epub 2006 Aug 10. Links
Lyme carditis: persistent local delayed enhancement by cardiac magnetic resonance imaging.Munk PS, Orn S, Larsen AI.
Lyme borreliosis (LB) is the most common tick-born disease in the Northern Hemisphere. During early disseminated Lyme disease cardiac manifestation can occur. We report a case of isolated Lyme myocarditis with transitory total atrioventricular (AV)-block and myocardial necrosis indicated by a rise in Troponin-T (TNT). Antibiotic treatment resulted in complete resolution of the AV-block, but a local epimyocardial contrast enhancement persisted as shown by cardiac magnetic resonance imaging (MRI).

PMID: 16904215
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:38

Cardiovascular involvement
Cardiovascular involvement occurs in fewer than 10% of patients with untreated Lyme disease and is more common in male patients than in female patients.

Palpitations, lightheadedness, and syncope may be a manifestation of varying degrees of heart block, including complete heart block, which occurs in 50% of patients with cardiac involvement. Lyme disease is an important reversible cause of heart block.

Chest pain and dyspnea can occur in the setting of Lyme pericarditis, myocarditis, and myopericarditis. Tamponade has been reported.

Cardiovascular findings
In patients with complete heart block, Canon A waves may be observed in the neck. A slow or irregular pulse may be palpated.
A cardiac rub, S3 and/or S4, may be auscultated in patients with myocarditis or pericarditis. Signs of tamponade very rarely can occur. In patients with chronic cardiac involvement with congestive heart failure, typical signs of congestive heart failure may be present.

http://www.emedicine.com/EMERG/topic588.htm
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:38

Lyme Disease and the Heart
Cardiac manifestations of Lyme disease are relatively uncommon and difficult to diagnose. According to Kornelia Keszler, MD,[5] of Yale University School of Medicine, the most readily recognized feature of cardiac involvement has been various degrees of heart block on ECG, which usually responds to antibiotic therapy.
Typical complaints of Lyme disease patients with cardiac involvement are chest pain, mild to moderate exertional dyspnea, and palpitations. (However, these symptoms also may be due to neuropsychiatric problems and musculoskeletal infection, so testing is important.) To evaluate such patients, cardiac testing should include thallium stress electrocardiography (ECG) and coronary angiography.

What does cardiac infection look like, and where are the organisms localized? Stanek and colleagues[6] found thickening of the walls of small endomysial vessels and infiltration by mononuclear cells. In murine studies, Pachner and colleagues[7] found 3 predominant locations for B burgdorferi in the heart. In mice infected for less than a month, spirochetes could be found mostly around blood vessels. By contrast, for longer infection periods, B burgdorferi could also be seen in cardiac myocytes, often surrounded by clear areas. B burgdorferi were also commonly found among collagen fibers.

Based on her series of cases and a review of the literature, Dr. Keszler drew the following conclusions. Thallium imaging typically reveals diffuse and patchy uptake of isotope in the myocardium, probably indicating involvement of the small vessels of the heart. Patients generally experience decreased exertional tolerance, as exhibited by a rapid increase in heart rate, but there is no ECG evidence of ischemia to account for the decreased tolerance. A variety of arrhythmias are seen, both ventricular and supraventricular, and are more common than heart block. At this time, it is not known whether treatment of Lyme disease will alter the thallium imaging. However, one study has found that cardiac abnormalities do not persist in patients treated for Lyme disease

http://www.medscape.com/viewarticle/418440
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:39

Borrelia infection as a cause of carditis (a long-term study).Bartunek P, Mrazek V, Gorican K, Bina R, Listvanova S, Zapletalova J.
Department of Internal Medicine IV, Charles University School of Medicine I, Prague, Czech Republic.

BACKGROUND: Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date. AIM: The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB. METHODS: Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels. RESULTS: The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae. CONCLUSION: Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.

PMID: 11233466
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:39

J Infect Dis. 1989 Jul;160(1):150-3. Links
Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease.de Koning J, Hoogkamp-Korstanje JA, van der Linde MR, Crijns HJ.
Department of Pathology, Laboratory for Public Health, Leeuwarden, The Netherlands.

Cardiac involvement occurring early in Borrelia burgdorferi infection is a clinical manifestation of human Lyme disease. Therefore, two patients with acute complete atrioventricular heart blocks and unexplained recurrent dizziness were studied. Both patients had significantly elevated serum titers of IgM and IgG antibodies to B. burgdorferi. Right ventricular subendocardial biopsies showed dense infiltrates consisting of lymphocytes and plasma cells. Silver staining revealed spirochetes characteristic of B. burgdorferi near and in the infiltrates, between the muscle fibers, and in the endocardium. One patient responded to penicillin; the other did not, necessitating installation of a pacemaker. Thus, permanent heart damage may result from cardiac involvement in Lyme disease.

PMID: 2732509
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:40

Scand J Infect Dis Suppl. 1991;77:81-4. Links
Lyme carditis: clinical characteristics of 105 cases.van der Linde MR.
Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands.

105 North American and European cases of Lyme carditis, being documented and in part published in the period 1977-1990, are reviewed and compared. The male: female ratio was 3:1, as well in Europe as in the USA. Transient atrioventricular block is the most frequent manifestation of Lyme carditis, with a remarkable similarity in the frequency of complete AV block and attending neurological illness in Europe and the USA. The distribution of (maximal observed) atrioventricular block in all patients existed of 49% third degree, 16% second degree and 12% first degree. Data of electrophysiological studies show that affection of the cardiac conduction system can be local or very diffuse. Other manifestations like rhythm disturbances, (myo)pericarditis and heart failure were less striking and have a less similar frequency in the European and American cases. Medicational therapy seems not to be an unconditional requirement for recovery of Lyme carditis itself, but cannot be withheld because of the proven beneficial effects of antibiotic therapy in other manifestations of Lyme borreliosis. Temporary pacemakers are frequently inserted, but pacemaker implantation is rarely needed. The overall prognosis of Lyme carditis seems to be good, although delayed recovery has been described and possible late manifestations have been suggested.

PMID: 1947815
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:40

1: Br J Rheumatol. 1994 Sep;33(9):862-6. Links
Lyme pericarditis leading to tamponade.Bruyn GA, De Koning J, Reijsoo FJ, Houtman PM, Hoogkamp-Korstanje JA.
Department of Rheumatology, Medisch Centrum Leeuwarden, The Netherlands.

We report the case of a 62-yr-old man who presented with Lyme pericarditis leading to cardiac tamponade shortly followed by an arthritis. IgM and IgG antibodies to Borrelia burgdorferi were demonstrated in serum by indirect immunofluorescence. Borrelia burgdorferi was demonstrated and identified in pericardial fluid by indirect immunofluorescence using serum from a patient with proven Lyme disease and by a monoclonal antibody immuno-gold silver stain. Spirochetes were also found in synovial biopsies using a silver stain. The tamponade was treated with pericardiocentesis; the arthritis was treated with intravenous ceftriaxone (2 g once daily) for 14 days. The patient recovered completely within days of commencing treatment. This case report demonstrates that borrelial infection may lead to pericarditis and cardiac tamponade.

PMID: 8081675
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:41

Kardiol Pol. 2007 May;65(5):565-70. Links
[Complete heart block and Lyme disease: report of two different cases and literature review.][Article in Polish]


Elikowski W, Małek M, Flieger J, Baszko A, Fagiewicz A, Wróblewski D.
Oddział Chorób Wewnetrznych Szpitala Miejskiego, ZOZ Poznań-Nowe Miasto, ul. Szwajcarska 3, 61-285 Poznań, tel.: +48 61 873 91 58, +48 501 410 461, faks: +48 61 873 91 60, e-mail: welikowski@wp.pl.

The most typical manifestation of cardiac involvement in Lyme disease (LD) is a high grade and usually fluctuating heart block, which is generally reversible, even self-limiting. Two cases of LD with a different course of complete heart block (CHB) are described. In a 43-year-old man admitted due to episodes of syncope, the diagnosis of LD was delayed - after pacemaker implantation - when he developed joint and neurological symptoms. Following ceftriaxone treatment atrioventricular conduction returned to normal. In the second case of a 26-year-old woman, presenting on admission with fatigue and flu-like symptoms, ECG showed CHB with a stable escape rhythm of about 52/min. Unlike the first case, she could recall neither a tick bite nor skin rash, but epidemiological history and serologic test results were indicative of LD. In this case, antibiotic therapy did not influence atrioventricular block, which was well tolerated. This suggested the coexistence of borreliosis and previously unrecognised congenital CHB.

PMID: 17577848 [PubMed - in process]
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:41

1: Med Mal Infect. 2007 Jul 13; [Epub ahead of print]Links
[Cardiac involvement in Lyme disease.][Article in French]


Lamaison D.
Service de cardiologie, CHU, place Henri-Dunant, 63000 Clermont-Ferrand, France.

Cardiac manifestations of Lyme Borreliosis are relatively infrequent, occurring within weeks after the infectious tick bite (median of 21 days), and resulting at this stage from a direct borrelial infection of the myocardium, as indicated by reports of spirochete isolation from pericardium and myocardium. They may persist or appear in the late, tertiary phase of the illness, being then more likely due to infection-triggered autoimmunity. Lyme carditis typically presents with a fluctuating degree of atrioventricular block that spontaneously resolves in several days. Rarely, myocarditis may occur with or without pericardial involvement, in patients presenting with chest pain, ST depression or T wave inversion, mimicking an acute myocardial infarction, and various arrhythmias are reported, as well as pericardial effusion or heart failure. A complete recovery is usually observed, spontaneous or after antibiotherapy. Severe myocarditis or Pericarditis leading to death is exceptional. The diagnosis of Lyme carditis is based on the same association of clinical and laboratory features as in Lyme disease without cardiac involvement. But the occurrence of conduction disturbances in healthy young people suggests screening for other criteria of Lyme disease. The management of Lyme carditis does not differ from the treatment of Lyme disease without carditis and is mainly based upon the use of doxycycline or ceftriaxone.

PMID: 17629649
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

User avatar
Yvonne
Posts: 2421
Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Mon 12 Nov 2007 10:42

Ned Tijdschr Geneeskd. 2007 Sep 1;151(35):1941-4.Links
[Total atrioventricular block following a tick bite][Article in Dutch]


Verbunt RJ, Visser RF.
Máxima Medisch Centrum, Postbus 7777, 5500 MB Veldhoven. r.verbunt@mmc.nl

A 40-year-old man was referred to the cardiology outpatient clinic with dizziness, palpitations and shortness of breath. He remembered being bitten by a tick two to three years previously, but had not noticed a characteristic skin rash. The ECG showed a prominent first degree atrioventricular (AV) block and ambulatory electrocardiographic monitoring showed an intermittent complete AV block. A definitive pacemaker was implanted. Antibodies to Borrelia were found. The patient was treated with ceftriaxone. In the weeks and months following implantation, the AV block disappeared completely. The reversibility of the AV block secured the diagnosis 'Lyme carditis with secondary AV block', and the pacemaker was explanted.

PMID: 17907546
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

Post Reply