Lyme Carditis

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Cardiovascular manifestations of Lyme disease were first reported nearly 30 years ago. This article describes Lyme carditis, its epidemiology, pathophysiology, methods of diagnosis, and treatment options.

Section snippets

Epidemiology

Lyme disease, caused by the spirochete B burgdorferi, is transmitted by the Ixodes tick [1], [2], [3], [4], [5], [6]. It is the most commonly reported vector-borne disease in the United States. Between 2003 and 2005, 64,382 cases were reported to the Centers for Disease Control and Prevention (CDC) [7]. The number of reported cases has remained relatively stable since 2002 (23,763 cases reported in 2002, 21,273 in 2003, 19,804 in 2004, and 23,305 in 2005) [7], [8]. The overall incidence of Lyme

Pathology

B burgdorferi can affect all layers of the heart [20], [21], [22]. Histologically, there is typically a transmural, inflammatory infiltrate composed nearly entirely of macrophages [23], [24], [25]. Very early in the disease process, small inflammatory nodules composed primarily of neutrophils and macrophages have been reported [22]. This is followed by infiltration of lymphoid cells, which create a characteristic band-like or plaque-like pattern. Myocyte necrosis also can occur, and subsequent

Clinical findings

Lyme carditis typically occurs between June and December, with a range of 4 days to 7 months after tick bite or EM [2], [28], [46]. The cardiac manifestations of early disseminated Lyme disease are usually coincident with other features of the disease (eg, EM, arthritis, or neurologic disease). One series found EM in 67%, joint complaints in 51%, and early neurologic sequelae in 27% of patients who had Lyme carditis [31]. There are, however, case reports of patients presenting with complete

Diagnosis

Appropriately diagnosing Lyme carditis is challenging, requiring confirmation of the association between a patient's historical, clinical, and laboratory data. It is diagnosed most accurately in cases in which there is historical evidence of borreliosis (tick bite, EM, arthritis, neurologic dysfunction) accompanied by cardiac manifestations (such as electrocardiographic conduction abnormalities, cardiomegaly, and congestive heart failure) in the setting of positive serologic testing for B

Treatment

Antibiotic therapy in the early stages of Lyme disease has been reported to prevent or attenuate later complications of the disease. In a retrospective study, Sanga and colleagues [76] demonstrated no increase in cardiac manifestations compared with controls in 176 patients who were treated with appropriate antibiotic therapy for Lyme disease at the time of initial presentation. Although antibiotics are recommended to clear the infection, there are no randomized controlled clinical trials that

Summary

Lyme disease is a globally occurring vector-borne illness caused by the spirochete B burgdorferi. It can affect multiple organ systems during the early disseminated phase, including the heart. The cardinal manifestation of Lyme carditis is self-limited conduction system disease at the level of the atrioventricular node. Temporary pacing may be necessary in up to one third of patients, but permanent heart block rarely develops. Myocardial and pericardial involvement also occurs commonly, but

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