Please be aware that this topic contains some deaths involved with Lyme &/or Lyme complications:
Postmortem confirmation of Lyme carditis with polymerase chain reaction.
Tavora F, Burke A, Li L, Franks TJ, Virmani R.
Cardiovasc Pathol. 2008 Mar-Apr;17(2):103-7.
We describe the case of a 37-year-old Caucasian man with a 1-month history of fevers, rash, and malaise who died unexpectedly on the day after he underwent medical evaluation. The only clinical cardiac abnormality found was that of second-degree atrioventricular block. At autopsy, a diffuse carditis, characterized by infiltrates of macrophages, lymphocytes, and eosinophils and primarily in an interstitial, endocardial, and perivascular distribution, was found. Serologic testing from blood drawn on the day before his death demonstrated IgG and IgM antibodies against B. burgdorferi, confirmed by Western blot. Postmortem polymerase chain reaction (PCR) performed in myocardial tissue amplified B. burgdorferi DNA encoding outer-surface protein A.
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Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node.
Cary NR, Fox B, Wright DJ, Cutler SJ, Shapiro LM, Grace AA.
Postgrad Med J, 66(773):258. 1990.
A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia (‘mesothelioma’) of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.
http://www.lymememorial.org/Fatality_Citations.htm
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Lyme carditis: a reversible cause of complete atrioventricular block.
J R Coll Physicians Edinb. 2010 Jun;40(2):121-2.
Bhattacharya IS, Dweck M, Francis M.
Cardiology Department, Victoria Hospital, Hayfield Road, Kirkcaldy KY2 5NG, UK. mark.francis@faht.scot.nhs.uk.
Abstract
A 54-year-old American woman presented with an episode of syncope. This had occurred against a background of several days of dizziness and palpitations. Her medical history included Bell’s palsy, which had been diagnosed three weeks earlier. On examination, she had a resting bradycardia of 31 beats per minute and her electrocardiogram demonstrated third-degree atrioventricular (AV) block. She was referred to cardiology for consideration of permanent pacemaker implantation. Given her facial nerve palsy and AV block, a diagnosis of Lyme borreliosis was suspected. Within 48 hours of initiation of ceftriaxone, she reverted to sinus rhythm, albeit with a marked first-degree AV block. Subsequent serology confirmed the diagnosis. Reversible causes of complete AV block should always be considered and appropriate therapy may avoid the need for permanent pacemaker insertion.
PMID: 21125053 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=21125053&dopt=abstractplus
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Lyme Carditis
BOSTON, July 22 /PRNewswire/
– 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/)
http://www.canlyme.com/card.html
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Cardiac manifestations of Lyme disease.
Pinto DS.
Harvard Medical School, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. Dpinto@caregroup.harvard.edu
Lyme disease is a vector-borne illness that can affect numerous organ systems during the early disseminated phase, including the heart. The clinical course of Lyme carditis is usually benign with most patients recovering completely. In rare instances, death from Lyme carditis has been reported. The cardinal manifestation of Lyme carditis is conduction system disease, which generally is self-limited. Heart block occurs usually at the level of the atrioventricular node but often is unresponsive to atropine sulfate. Temporary pacing may be necessary in more than 30% of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement can occur but generally is mild and self-limited. Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, EM, or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea. Serologic studies and endomyocardial biopsy can only support the clinical diagnosis in the correct setting, and MR imaging, echocardiography, and gallium scanning have utility in selected circumstances. No treatment has been shown clearly to attenuate or prevent the development of Lyme carditis, but mild carditis generally is treated with oral antibiotics and severe carditis with intravenous antibiotics in an effort to eradicate the infection and prevent late complications of Lyme disease. There is conflicting evidence regarding the role that B. burgdorferi plays in the development and progression of chronic congestive heart failure. Because of the significant false-positive ELISA rate in this population and the unclear benefit of antibiotic therapy, confirmatory Western blot analysis is recommended. Routine therapy and screening of patients with idiopathic dilated cardiomyopathy is of limited utility and should be reserved for patients with clear history of antecedent Lyme disease or tick bite.
http://www.ncbi.nlm.nih.gov/pubmed/11982302
PMID: 11982302 [PubMed - indexed for MEDLINE]
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Complete heart block due to lyme carditis.
Lo R, Menzies DJ, Archer H, Cohen TJ.
Winthrop-University Hospital, 259 First Street, 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.
http://www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%2012777681
PMID: 12777681 [PubMed - in process]
