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Lyme disease can affect heart conduction

Lyme disease, the increasingly common tick-borne infection, can affect the heart, as well as other organs, according to a report1 published online recently by Circulation.

Lyme carditis occurs when Lyme bacteria that have disseminated from the site of initial deposition in the skin into heart tissue. They can affect areas including the conduction system around the atrioventricular node, the outer or inner membranes of the heart, the cardiac muscle, and more rarely, cardiac blood vessels or heart valves, say the authors.

The predominant cardiac manifestation is partial heart block caused by impairment of the electric signal that controls contraction of the upper and lower chambers of the heart, they add. This is occasionally complete and permanent, requiring insertion of a pacemaker. Myocarditis or pericarditis may occur, and death has been reported in a few cases, they say.

Lyme carditis should be considered in anyone suspected or confirmed to have Lyme disease who experiences cardiac symptoms. An ECG that demonstrates varying degrees of heart block supports the diagnosis of Lyme carditis.

Carditis may resolve spontaneously, but standard antibiotic treatment can shorten disease duration and prevent complications. For mild to moderate heart disease, amoxicillin or doxycycline is given by mouth for 14 to 21 days. Severe cardiac disease usually is treated with ceftriaxone or cefotaxime given by intravenous infusion over 14 to 21 days.

Longer courses of antibiotics have not been shown to be superior to the standard duration and incur increased risk of side effects, as well as added expense. Hospital admission and continuous monitoring are advisable for patients with moderate to severe heart block, because the degree of block may fluctuate and worsen very rapidly in such patients. For some patients, hospital admission with temporary (or rarely, permanent) pacemaker placement is necessary, but the general prognosis for Lyme carditis is excellent, they conclude.

References

1. Krause PJ, Bockenstedt LK. Lyme disease and the heart. Circulation 2013;127:e451–4. http://dx.doi.org/10.1161/​CIRCULATIONAHA.112.101485

Published on: February 28, 2013

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