Lyme Disease and the heart

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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Yvonne
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Re: Lyme Disease and the heart

Post by Yvonne » Wed 11 Aug 2010 19:33

http://www.invasivecardiology.com/article/1786

Complete Heart Block Due to Lyme Carditis
Case Report. A 63-year-old woman with a history of hypertension, for which she was taking oral verapamil 360 mg daily, presented with a one-week history of increasing dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle swelling and an 8-lb. weight gain. She admitted to having a tick bite while vacationing in Cape Cod, Massachusetts, three weeks prior, but denied any fever or rash at that time. Routine blood work and Lyme titers were drawn, and the patient was referred to a cardiologist. A week later at her cardiology appointment, she was found to be in complete heart block and referred Winthrop-University Hospital for admission.
Physical exam revealed an elderly woman in mild respiratory distress. Her blood pressure was 108/72 mmHg, with a heart rate of 50 beats per minute, respiratory rate of 16 respirations per minute, and temperature of 98.1 oF. She had small erythematous lesions on the left side of her upper back, consistent with erythema chronicum migrans. She did not have any jugular venous distention or carotid bruits. Her lung bases were dull to percussion, with decreased breath sounds. Her heart sounds S1 and S2 were audible, and no S3 gallop was noted. Abdominal exam was benign. She had 1+ pitting edema on both lower extremities.
Her chest radiograph revealed cardiomegaly, pulmonary venous congestion and bilateral pleural effusions. The electrocardiogram revealed third-degree heart block with a ventricular rate of 46 beats per minute, in the setting of an old right bundle branch block (Figure 1) present in previous electocardiogram. Her laboratory data revealed no cardiac enzyme elevation and normal electrolyte and hematology screens, thyroid function and coagulation profile. Lyme antibody screen drawn one week prior to admission was positive at 4.61. Quantitative Lyme IgM by EIA was positive at 2.46. Western blot analysis was positive for Lyme IgG with 10 of 10 banding patterns matching.
She was admitted to a monitored bed and treated with intravenous ceftriaxone 2 gm daily and oral prednisone 60 mg daily. Her heart rhythm continued to fluctuate between second degree 2:1 AV block and complete heart block. An electrophysiology study revealed the AV block to be at the level of the AV node and the patient had normal His-Purkinje function. The patient’s HV interval was 40 milliseconds. Within days of treatment, her symptoms improved and her electrocardiogram had improved to first-degree AV block (Figure 2). She was discharged after an uncomplicated hospital stay home to complete a three-week course of intravenous ceftriaxone. She subsequently had complete resolution of her AV conduction disorder and symptoms. Figure 3 shows the electrocardiogram six months after treatment.
Discussion.
The cardinal manifestation of Lyme carditis is conduction system disease. Myocardial and pericardial involvement can occur, but is generally mild and self-limited.2 Fluctuating degrees of AV block, occasional acute myopericarditis or mild left ventricular dysfunction and rarely cardiomegaly or fatal pericarditis have been known to occur. The only reported chronic manifestation of Lyme disease is of a chronic dilated cardiomyopathy.3
Cardiovascular manifestations are acute, often occurring within 21 days of exposure, and most commonly result in second- or third-degree AV block that resolve spontaneously within days or weeks.4 Heart block occurs usually at the level of the atrioventricular node, but is often unresponsive to atropine sulfate.2 Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops.2
Diagnosis of Lyme carditis is based on the clinical history and symptoms and exposure to an endemic region and the only definitive test for diagnosing Lyme carditis is by histopathology. Most patients will be able to recollect a tick bite, but the typical erythema chronicum migrans will appear in 60–80% of cases. Laboratory diagnosis includes isolation of Borrelia Burgdorferi from a Barbour–Stoenner–Kelly medium. Serological laboratory tests include enzyme-linked immunosorbent assays for IgG and IgM to Borrelia Burgdorferi followed by a confirmatory western blot. The diagnosis of Lyme disease can also be made by the polymerase chain reaction (PCR), but this method has not been standardized for routine diagnosis of Lyme disease.5
An echocardiogram is likely to yield normal myocardial function in acute Lyme disease. Slight nonspecific pericardial effusions have been noted in European patients with Lyme disease.6 However, in chronic Lyme carditis or patients with long-standing untreated disease, echocardiography is a useful tool in diagnosing and monitoring treatment in dilated cardiomyopathy secondary to Lyme disease.7
Cardiac troponin levels are useful in diagnosing the rare cases of Lyme myocarditis and myopericarditis. Cardiac enzymes are not elevated in the majority of cases of Lyme carditis in which only atrioventricular block are present.
All symptomatic patients with presumptive or definitive diagnosis of Lyme carditis will need effective intravenous antibiotic treatment. Patients with first- or second-degree AV block can be treated with an oral antibiotic regimen for 14–21 days. Patients with third-degree AV block or pauses need to be treated with intravenous ceftriaxone for 14–21 days.8 Most patients will have symptomatic improvement within 7 days of starting antibiotics (Table 1).
Conclusions.
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. Patients with suspected Lyme carditis require hospitalization for cardiac monitoring. They usually exhibit symptoms of dizziness, dyspnea on exertion, palpitations or syncope, primarily due to varying degrees of AV block. Patients that fluctuate between third degree and asystolic pauses will require temporary transcutaneous or transvenous pacing. Symptoms and the electrocardiogram usually improve with proper antibiotic treatment, and do not usually require the implantation of a permanent cardiac pacemaker. The case presented highlights the typical findings of AV block secondary to Lyme disease and demonstrates total reversibility after a complete course of antibiotics.
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Spanky
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Re: Lyme Disease and the heart

Post by Spanky » Wed 11 Aug 2010 22:24

From the above:
All symptomatic patients with presumptive or definitive diagnosis of Lyme carditis will need effective intravenous antibiotic treatment.

This article (below) was what was available at the time that I was having my trouble. (2000). At that point, I had been diagnosed with Lyme, and had an echocardiogram performed that showed a hypertrophied left ventricle, along with an enlarged heart and regurgitating mitral and tricuspid valves. You certainly could feel this, or feel that something was badly wrong. My understanding at the time was that my doc thought the echo most likely reflected "Lyme carditis".

Again, as I understand it, this would be a situation where an iv in Lyme disease might be considered to be appropriate. (Others, though, may enjoy the humor in this statement: "There are two reported cases of death associated with lyme carditis". This article is from back in '94, though).

Pretty funny, funny stuff...(I certainly thought so at the time)...especially when I couldn't get the iv...hilarious.



Lyme Carditis: Value of Echocardiography

Reprinted by permission from Primary Cardiology, April 1994.

Rama Garimella M.D., Leonard Moss D.O., Daniel Shindler M.D.

We became interested in the potential diagnostic utility of echocardiography in Lyme carditis when a young medical student with Lyme disease presented with erythema chronicum migrans, syncope, meningitis and an abnormal electrocardiogram demonstrating second degree Mobitz I heart block. This resolved over a period of several days with a residual first degree heart block. An echocardiogram revealed normal myocardial function. There was no evidence of pericardial effusion. The left ventricular function was normal. The only abnormal echocardiographic findings were a consequence of the conduction abnormalities.

In the original description of 20 patients with Lyme carditis (1) one patient had a pericardial friction rub on auscultation and another had a small pericardial effusion. Otherwise all patients tested had normal valvular structure, normal cardiac chamber dimensions and no hypertrophy. In another report (2) 4 patients were described. Three of the echocardiograms in these patients were normal. One showed slight hypokinesis of the proximal portion of the interventricular septum but there was no uptake on a gallium scan, therefore, no clinical evidence of inflammation.

There are two reported cases of death associated with lyme carditis. One did not undergo echocardiographic evaluation and was found dead after admission without evidence of agonal struggle, suggesting death due to arrhythmia. Although an echocardiogram was not performed, there was autopsy evidence of left ventricular hypertrophy and focal calcification at the base of his aortic valve. More importantly, there was also evidence of myocarditis involving myocardium, endocardium and pericardium. The findings are not specific for Lyme carditis but are certainly diagnosable to some extent by echocardiography.(3)

A second patient with fatal carditis presented a provocative finding which may or may not have been related to the Lyme disease. This patient had endodermal heterotopia (mesothelioma) of the atrio ventricular node.(4) The authors raised the possibility that this may somehow be related to the infection, and may account for the frequent occurrence of atrio ventricular block in Lyme disease. Inclusion cysts have been reported in autopsies of patients dying from heart block.(5) They, in essence, indicated the possibility of a pathological substrate for heart block in Lyme carditis. Recently it was actually possible to successfully excise a mesothelioma of the atrio ventricular node, making this a treatable entity if it is diagnosed.(6) In this particular patient it was an incidental finding during open heart surgery for a secundum atrial septal defect. However, with the increasing sophistication of echocardiographic tissue characterization techniques and with the availability of high resolution echo images from the esophagus it is conceivable that infiltration of the atrioventricular node by abnormal tissue may be diagnosable premortem.

It is already possible to diagnose in vivo the presence of myocardial fibrosis (reported in some patients with Lyme carditis) by the use of myocardial biopsy. It has also been shown that therapy will reverse some of this process. Echocardiographic tissue characterization techniques are being developed for this same purpose. One manufacturer already provides videodensitometry on ultrasound equipment for this purpose. Patients who live in endemic Lyme areas may present with ventricular arrhythmias.(7) Tissue characterization with echocardiography may, in the future, be useful in identifying cardiac involvement after the acute phase of the disease in these people.

Long term Lyme carditis has been associated with pericardial effusions as well as left ventricular hypertrophy (both diagnosable with the use of echocardiography).(8) Since many patients with Lyme disease are young, it is also worthwhile to comment on the known manifestations of this disease in children. In 32 randomly selected patients ages 1-17 presenting with Lyme disease, cardiac evaluation, including echocardiography, was performed. Cardiac evaluation was felt to be beneficial in diagnosing the presence of myocarditis and pericarditis both in symptomatic and asymptomatic children.(9)

Lyme Disease has been implicated as a possible etiologic agent in dilated cardiomyopathy.(12,13,14) It is, therefore, fitting to describe the multitude of information that can be gained about cardiac function using echocardiography combined with Doppler. Dilated cardiomyopathy is manifested by both left ventricular cavity dilatation as well as hypokinesis of the left ventricular walls. Since there are often electrocardiographic conduction abnormalities as well, the decreased overall left ventricular contractility may sometimes mimic regional wall motion abnormality. Digital techniques may be needed to generate a regional wall motion analysis. On color Doppler, one finds slow blood velocities with delayed displacement of the color from the mitral annulus to the left ventricular apex, giving the color pattern a puff like appearance. (15)

The mitral Doppler inflow velocity abnormalities associated with left ventricular dysfunction can be stratified into one of three patterns. In one pattern, there is acceleration of the inflow velocity through the mitral valve following atrial contraction with relatively slower velocity in the early phase of diastole. In an intermediate stage, there can actually be a normal mitral inflow pattern. This is referred to as pseudonormalization. The pulmonary venous inflow pattern however, may remain abnormal manifesting predominant filling in diastole rather than systole. Finally, the most ominous pattern is one of a brief inflow in early diastole with short deceleration of flows and little if any flow in late diastole. This pattern is ominous and has been associated with decreased longevity in patients with dilated cardiomyopathy.(16)

Additional findings not to be overlooked are the classic M- mode observations of decreased mitral leaflet excursion with increased diastolic separation of the anterior mitral leaflet away from the left ventricular septum. Left ventricular dilatation may distort the mitral annulus, giving rise to mitral insufficiency. Often, mitral insufficiency appears moderate rather than severe and the color flow jet appears central rather than impinging on one of the left atrial walls. Once the patient progresses to biventricular failure, there may be dilatation of the tricuspid annulus with tricuspid insufficiency as well. Eventually, one also may observe increases in tricuspid insufficiency velocities indicating evidence of pulmonary hypertension.

Since echocardiography is non-invasive it can be used serially to follow the evolution of any observed findings. Thus, although echocardiography does not provide pathognomonic findings in patients with Lyme carditis it is non-invasive and should be part of the initial evaluation. In our patient, the echocardiographic findings were related to the conduction abnormality rather than to actual myocardial involvement. As echocardiographic imaging improves and transesophageal echo probes get smaller, the tissue characteristics provided by high resolution echocardiography may be clinically useful in the evaluation of this important complication of Lyme disease.
REFERENCES
1. Steere AC, Batsford WP. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Int Med 1980;93[part1]:8-16.

2. Van der Linde MR, Crijns HJGM. Range of av conduction disturbances in Lyme borreliosis: a report of 4 cases and review of other published reports. Br heart J 1990;63:162-8.

3. Marcus LC, Steere AC. Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Ann Int Med 1985;103:374-376.

4. Cary NRB, Fox B. Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node. Postgrad Med 1990; 66,134-136.

5. Barr JR, Pollock P. Inclusion cyst of the myocardium in a patient with complete heart block. Canad Med Assn J 1968;98:52-53.

6. Balasundaram S, Halees SAL. Mesothelioma of av node: first successful follow-up after excision. Eur Heart J 1992;13:718-719.

7. Vlay SC, Pervan JP. Ventricular tachycardia associated with Lyme carditis. Am Heart J 1991:1558-1560.

8. Casans I, Villar A. Lyme myocarditis diagnosed by indium-111- antimyosin antibody scintigraphy. Eur J Nucl Med 1989;15:330-331.

9. Woolf PK, Lorsung EM. Electrocardiographic findings in children with Lyme disease. Pediatric Emergency Care 1990;7:21-23.

10. Cox J, Krajden M. Cardiovascular manifestations of Lyme disease. Am Heart J 1991;1449-1455.

11. McAlister HF, Klementowicz PT. Lyme carditis: an important cause of reversible heart block. Ann Int Med 1989;110:339-345.

12. Stanek G, Klein J, Bittner R, Glogar D. NEJM 1990;322:249-252.

13. Klein J, Stanek G, Horvat R, Holzinger C, Glogard D. Eur Heart J 1991;12:73-75.

14. Stanek G, Klein J, Bittner R, Glogar P. Scand J Infect Dis. Suppl. 77: 85-87, 1991

15. Shindler D,Shindler OI,Kostis JB. Color Doppler diastolic "smoke puff" in decreased left ventricular function, incidence and interobserver variability. Chest 96(2):201s, August 1989.

16. Pinamonti B,Lenarda A DI,Sinagara G,Camerini F and the Heart Muscle Group. Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: clinical, echocardiographic and hemodynamic correlations and prognostic implications. JACC 1993;22:808-15.



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Yvonne
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Re: Lyme Disease and the heart

Post by Yvonne » Fri 13 Aug 2010 10:33

Spanky wrote :
This article (below) was what was available at the time that I was having my trouble. (2000). At that point, I had been diagnosed with Lyme, and had an echocardiogram performed that showed a hypertrophied left ventricle, along with an enlarged heart and regurgitating mitral and tricuspid valves. You certainly could feel this, or feel that something was badly wrong. My understanding at the time was that my doc thought the echo most likely reflected "Lyme carditis".
I read on the internet that regurgitation can develop when an illness or an infection of the muscle or tendon cords around the mitral valve weakens

Read that normally they begin to try to treat it with betablockers. Is that how they treated you ?

And if I understood it well the tricuspidalisklep is on the right site of your heart. Does this mean that you had both right and left problems ?

And did they do an another echocardiogram now you have no heartproblems anymore to watch if it really is better ?
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Re: Lyme Disease and the heart

Post by Spanky » Fri 13 Aug 2010 21:50

"Yvonne":
I read on the internet that regurgitation can develop when an illness or an infection of the muscle or tendon cords around the mitral valve weakens

Read that normally they begin to try to treat it with betablockers. Is that how they treated you ?
Not initially, not in the beginning with the Beta-blockers. I was having these brief periods of blacking out*. (I know, funny, isn't it)?

This was at the time when the first echocardiogram was done, mentioned, above. So, I was reluctant to take the beta-blockers because I was afraid of taking something that relaxes the heart muscle. It seemed to me to be under-performing as it was. In the beginning, there was a very noticeable arrythmia...I described it as feeling like a "fish flopping" in your chest. There's no mistaking that. You can feel this. Ka-thump...(pause)...ka-thumpa-ka thump-thump. That kind of stuff...if you put your hand on my chest, you could feel it. Irregular.

Later, I developed a tachycardia and palpitations and have been taking beta-blockers for that, yes. If I did anything physical, scooped snow from the driveway, for instance, it might take several hours for the heart to calm down...usually at around 115-130 bpm. Sometimes you would get the palps and rapid heart beat for no apparent reason at all. Eating would seem to trigger it, sometimes.

Seems fine now. I am about 69 bpm, now. But I had the tachycardia thing for years and years. Uncomfortable...but probably not dangerous.

Later added: This comment perhaps incorrect. Maybe wishful thinking. See:

http://www.lymeneteurope.org/forum/view ... 066#p23066

The tachycardia and the palps have now stopped...and I am no longer taking the beta-blockers. (These have some side-effects, too).
And if I understood it well the tricuspidalisklep is on the right site of your heart. Does this mean that you had both right and left problems ?
I assume so. I don't know. There were three or four echoes done at various times. None recently. All of them showed some abnormality. How serious? Who knows? Was it caused by Lyme? We think so. I didn't have any problems before. And I'm still here...sooo...
And did they do an another echocardiogram now you have no heartproblems anymore to watch if it really is better ?
Last one wasn't too bad. If I remember right, it did show the left ventricle to be "concentrically hypertrophied" still, but that was several years ago, now. I'm just not going to worry about things I can't do anything about.

And, as I have mentioned, there were some very emotionally stressful things going on in my life at that time, which probably didn't help, either. But I was already in trouble before those things happened. I was already sick.

All I know is that I feel fine, now.

And I hope others take away some hope in that. As bad as I think I was and as bad as I remember things being...I am okay, now.

But I am still bad... :lol:
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*What would happen is that I would feel like I was getting very sleepy, very suddenly...and then wake up feeling a sense of being all refreshed like I had slept eight or ten hours, but could only have been out very briefly. There is a very strange sensation of pleasantness, or euphoria, associated with this.
Last edited by Spanky on Sun 15 Aug 2010 19:24, edited 2 times in total.

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Yvonne
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Re: Lyme Disease and the heart

Post by Yvonne » Sat 14 Aug 2010 10:37

Thanks for your reply
In the beginning, there was a very noticeable arrythmia...I described it as feeling like a "fish flopping" in your chest. There's no mistaking that. You can feel this. Ka-thump...(pause)...ka-thumpa-ka thump-thump. That kind of stuff...if you put your hand on my chest, you could feel it. Irregular.
Yes, my daughters have that too. They feel it that way also. The electrocardiography and/or holter monitor shows arrhythmias and extrasystoles for both


Later, I developed a tachycardia and palpitations and have been taking beta-blockers for that, yes. If I did anything physical, scooped snow from the driveway, for instance, it might take several hours for the heart to calm down...usually at around 115-130 bpm. Sometimes you would get the palps and rapid heart beat for no apparent reason at all. Eating would seem to trigger it, sometimes.
This experience my daughters also


Seems fine now. I am about 69 bpm, now. But I had the tachycardia thing for years and years. Uncomfortable...but probably not dangerous

Yes, I have tachycardia too and also for many years but with me, despite the medication at rest it is often 100 or more

The tachycardia and the palps have now stopped...and I am no longer taking the beta-blockers. (These have some side-effects, too).
Thankfully it is over. I also suffer from side effects of heart medication


I'm just not going to worry about things I can't do anything about.
I do worry. Not about me but about my daughters. I sometimes fear that they will die


All I know is that I feel fine, now.
That is really great


But I am still bad...
:lol: Image
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Re: Lyme Disease and the heart

Post by Yvonne » Sat 14 Aug 2010 11:37

http://journals.lww.com/em-news/Fulltex ... ree.9.aspx

Lyme Carditis: From Asymptomatic First-Degree Heart Block to Dilated Cardiomyopathy
A previously healthy 17-year-old girl was brought to our ED after a syncopal episode that occurred while she was standing in her kitchen earlier that evening. According to her mother, who was speaking to her at the time of the episode, she suddenly dropped to her knees and then lost consciousness for approximately 10 to 20 seconds. When she regained consciousness, she quickly returned to her baseline mental status, denying any confusion or lethargy. In fact, during our interview with the patient, she reported feeling great immediately after this event.

Her ECG showed an accelerated junctional rhythm with a rate of 120 beats per minute. Further history revealed that she had been seen by her pediatrician on the previous day for evaluation of a rash. She described the rash as it appeared that day as several erythematous patches approximately 5 cm to 6 cm in diameter that were located on her left forearm, abdomen, and thighs. She denied any previous skin conditions such as eczema or psoriasis, and could not recall any recent exposures to plants, ticks, new medications, or cleaning products. She was given a prescription for diphenhydramine, and aside from some general fatigue, was doing well up to the time of her syncopal event.
A repeat ECG showed a first-degree AV block with a markedly prolonged PR interval of greater than 400 ms. Physical exam revealed multiple annular, erythematous, macular lesions with central clearing. (Figures 1 and 2.) These were located on her torso, back, and upper and lower extremities.


Although the patient could not recall any recent tick exposure, she lived in an area endemic for Lyme disease, and reported being outdoors for much of each day. The diagnosis of Lyme carditis was made, she was started on ceftriaxone for presumed disseminated Lyme disease, and she was admitted to the pediatric ICU for monitoring
Diagnosis

The diagnosis of Lyme carditis can be relatively straightforward when new onset conduction abnormalities occur simultaneously with other signs and symptoms of disseminated Lyme disease, as was the case with this patient. If the cardiac manifestations occur in isolation, however, a high index of suspicion is necessary to make the diagnosis. The diagnosis can be confirmed by serology testing using ELISA or Western blot analysis, but it is important to point out that serology testing will be negative during the first several weeks of infection. Eliciting a history of tick exposure, erythema migrans rash, or outdoor activities in an endemic area is important when considering the diagnosis.

Although any area of the conduction system can be affected, the most common presentation is a first-degree AV block. One of the hallmarks of Lyme carditis is the rapidity with which the conduction abnormalities can change. It is not uncommon to see several different degrees of AV block within a relatively short period of time. It is estimated that approximately 50 percent of patients with Lyme carditis will develop complete heart block during the course of their disease. (Clin Pediatr Emerg Med 2004;5[5].) Those with a markedly prolonged PR interval (≥300 ms) seem to be at the greatest risk for progression to complete heart block. The ECGs shown here were all recorded from another of our patients with Lyme carditis over a period of only 24 hours. (Figures 3-5.) This patient was a 58-year-old man who presented with atypical chest pain, no rash, and no known tick exposure. The diagnosis was confirmed by serologic testing, and he recovered completely.
Treatment

Once the diagnosis of Lyme carditis is made, antibiotics effective against Borrelia burgdorferi should be initiated. Although there is good evidence that disseminated Lyme disease should be treated with parenteral antibiotics, there is no consensus regarding treatment for isolated Lyme carditis. The Infectious Diseases Society of America recommends oral therapy with doxycycline or amoxicillin for asymptomatic 1st or 2nd degree heart block. Furthermore, there is no evidence that treatment with antibiotics alters the course of the conduction abnormalities seen in Lyme carditis. It seems prudent in patients with high-grade AV block caused by Lyme disease, however, that parenteral antibiotic therapy should be administered in a monitored setting

Parenteral antibiotic choices include ceftriaxone 2 g QD, cefotaxime 2 g BID, or penicillin G 200,000 to 400,000 units/kg/day divided into six doses. Duration of treatment for disseminated disease should be for four weeks. Oral regimens include doxycycline 100 mg BID or amoxicillin 500 mg TID with treatment durations ranging from 14 to 21 days. (Clin Infect Dis 2000;31(Suppl: 1):S1-14.)
Symptomatic patients should be admitted to a monitored bed during initiation of therapy due to the potential of rapid progression to a high-grade block. It is worth noting that bradycardia in patients with complete heart block typically will not respond to atropine, and temporary pacing may be necessary.

The prognosis for patients with Lyme disease and cardiac involvement is very good. Most conduction abnormalities will resolve within three to six days. Occasionally a persistent 1st degree AV block persists for several months after treatment, but these are typically well tolerated and also will resolve spontaneously. Very rarely, patients can have a persistent high-grade block that necessitates pacemaker placement. There have been case reports of dilated cardiomyopathy secondary to Lyme myocarditis, but these appear to be extremely rare and respond well to appropriate therapy.
Although this case was a relatively straightforward diagnosis given the multiple erythema migrans lesions in a new conduction abnormality in a young woman who resided in an area endemic for Lyme disease, Lyme carditis often can present a challenging diagnostic dilemma, particularly when the cardiac manifestations of this infection present in isolation. A thorough history focusing on risk factors and subtle symptoms combined with a high index of suspicion is necessary for any patient who presents with a newly diagnosed heart block
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Re: Lyme Disease and the heart

Post by Yvonne » Sat 14 Aug 2010 11:55

My youngest daughter has some things that are described in the above text.

In the latest letter from the cardiologist to the GP he wrote :

"supraventricular ectopy with periods of accelerated atrial rhythm and atrial invasion focus to slow focus SR.
sometimes prolonged PQ time (first degree AV block) is not permanent.average SR 80/minperiodic

prolonged PQ intervals and supraventricular ectopy.Which we have to be suspicious of Sick Sinus Syndrome at the patient"



With Lyme different degrees of AV block can be noticed but also Sick sinus syndrome :

http://www.lymeneteurope.org/forum/view ... 404#p22404

http://www.lymeneteurope.org/forum/view ... 405#p22405

I also know of 2 Dutch Lymepatients who have this
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Re: Lyme Disease and the heart

Post by Spanky » Sat 14 Aug 2010 16:29

Yvonne wrote:
Yes, I have tachycardia too and also for many years but with me, despite the medication at rest it is often 100 or more
Yes. And if you have this when you are trying to lie down for sleep at night...you might as well get out of bed and play all night solitaire until it's over.

Like a freight train in the night...full speed down the track.

At some point, I remember hearing this public service announcement about when you should get immediate attention at the Emergency Room of the hospital for chest pain, irregular rhythym...and I just sort of laughed...I would be in there all the time.

You just have to live with the uncertainty, and become fatalistic, I think...there are no clear answers. The cardiologist that I saw here was of incredibly little help...other than to tell me what he didn't understand. They simply don't see enough cases to be knowledgeable. Or, maybe worse yet, they see the cases, but don't recognize them...
I also suffer from side effects of heart medication
I was using the Beta-blockers only when I was having a problem. My doc said, though, that he wanted me to take them regularly. As soon as I started taking them again...I knew what one symptom of my "chronic Lyme" had been...the side effects of those Beta-blockers...were making me feel all tired and worn-out.

I wonder how many people online who have some symptom of "chronic Lyme" may also be suffering from some medication side-effects?
I do worry. Not about me but about my daughters. I sometimes fear that they will die
I think that the palpitations and arrhythmia alone probably cause some understandable anxiety. And that's natural...
But yeah, from my view, the anxiety was in not knowing what to do...and you try to take care of yourself, too, for the benefit of others. There's just no good advice.

(From above quoted article):
A previously healthy 17-year-old girl was brought to our ED after a syncopal episode that occurred while she was standing in her kitchen earlier that evening. According to her mother, who was speaking to her at the time of the episode, she suddenly dropped to her knees and then lost consciousness for approximately 10 to 20 seconds. When she regained consciousness, she quickly returned to her baseline mental status, denying any confusion or lethargy. In fact, during our interview with the patient, she reported feeling great immediately after this event.
WOW. YES. That's it! Exactly. Son of a -----! Thank you, thank you, thank you. I have never seen this associated with Lyme disease. That's...wow.

This happened a couple of times, early on. And yeah...that is the weird, weird part of it...you feel great upon regaining full consciousness. (Apparently, this sensation has been discovered by teens who are now actually choking themselves in order to experience this feeling. Two girls died here last week while doing this). :shock:

At the time, I was having a lot of trouble and my legs felt very heavy. I called it "lead legs". This is around when the first echo was done.

I remember one time was in the barber chair. I would guess I was "out" for less than a minute...as the barber was away...and I awoke when he returned. But you sort of "crumple"...just fade to black...I remember feeling like I was at the bottom of a swimming pool...

So far as I know...there are NO known cases of dilated cardiomyopathy associated with Lyme disease reported here in the US...so there are some definite differences between US and European cases.

I hope things are better for you and your girls, Yvonne...and I'm not sure that it is safe to use me as an example, but as I said, I hope it is encouraging to others to hear that I am better... :D

-----------------------------------------------------------------------------------------------------------

PS. And apparently, not only should I probably have had an iv...but one in a hospital?
Symptomatic patients should be admitted to a monitored bed during initiation of therapy due to the potential of rapid progression to a high-grade block. It is worth noting that bradycardia in patients with complete heart block typically will not respond to atropine, and temporary pacing may be necessary.

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Re: Lyme Disease and the heart

Post by Yvonne » Sat 14 Aug 2010 19:33

Spanky wrote
Yes. And if you have this when you are trying to lie down for sleep at night...
I don't have that

I was using the Beta-blockers only when I was having a problem. My doc said, though, that he wanted me to take them regularly. As soon as I started taking them again...I knew what one symptom of my "chronic Lyme" had been...the side effects of those Beta-blockers...were making me feel all tired and worn-out.
I don't use Betablockers. I had received them in the past from my GP for high blood pressure. But I felt like shit and after a few days I was told her that no longer take them
The statins that I got from the cardiologist, I refused to take further.
The side effects of current medications that I have are mainly related to stomach and intestines

I wonder how many people online who have some symptom of "chronic Lyme" may also be suffering from some medication side-effects?
When I notice side effects that really bothers me that I can quit the medication I guess it is from (possibly in consideration) I did that recently with the ascal cardio and got something else instead from the cardiologist

I hope things are better for you and your girls, Yvonne...
Thank you. But it rather is seems more like it is going to be getting worse

and I'm not sure that it is safe to use me as an example
I don't do that.
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

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Yvonne
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Joined: Fri 27 Jul 2007 16:02

Re: Lyme Disease and the heart

Post by Yvonne » Sat 14 Aug 2010 19:37

Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node :

http://ukpmc.ac.uk/backend/ptpmcrender. ... obtype=pdf
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

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