Lyme disease causes cardiac issues

Of their article, “Lyme carditis–induced sinoatrial dysfunction after initiation of focused oral antibiotic remedy: A case report,” Chen and colleagues describe a case during which Lyme carditis triggered sinoatrial node dysfunction that manifest greater than 1 week after antibiotic therapy. [1]

 

The case concerned a 46-year-old man with Lyme disease who introduced to the clinic with cardiac issues, which initially manifest as palpitations.

The affected person lived in a Lyme endemic area and reported that one month earlier, he had a “pinching sensation in his proper thigh with an related macular erythematous rash,” according to the authors. He didn’t discover a tick chew.

The person later developed excessive fevers, fatigue, and a second rash on the higher left a part of his physique.

Lyme disease testing was optimistic for IgG and IgM titers.

“He had initially began cephalexin at house and was subsequently prescribed a 2-week course of doxycycline,” the authors state.

“Through the second week of his antibiotic remedy, he famous palpitations and an uneasy feeling in his chest that occurred following train.”

After 13 days of doxycycline for the therapy of Lyme disease, the affected person skilled cardiac issues, together with palpitations and fatigue.

He was admitted to a clinic for analysis, the place a cardiac MRI was carried out. Nevertheless, findings have been regular.

In the meantime, a cellular electrocardiogram (ECG) detected “sinus pauses with durations of each large and slender advanced escape rhythm,” the authors state.

“Lyme carditis is a possible reason for sinoatrial dysfunction and will happen in sufferers who’ve not too long ago been handled with oral antibiotics.”

Additional testing revealed sinus bradycardia (a slower than regular coronary heart price) and the affected person was handled with intravenous ceftriaxone.

In keeping with the authors, “he was identified with partially handled early disseminated Lyme disease, thought-about to be the etiology of his sinoatrial nodal illness.”

“Lyme carditis manifesting as remoted sinoatrial dysfunction may not end in detectable abnormalities on cardiac magnetic resonance imaging [MRI].”

The affected person’s cardiac issues resolved after acceptable therapy with IV ceftriaxone.

 

Authors Takeaways:

• “Though Lyme carditis mostly manifests as atrioventricular nodal block, all cardiac tissues are prone to spirochete invasion.”
• Whereas a cardiac MRI can help with diagnosing Lyme carditis, on this case, the affected person’s MRI outcomes have been regular.
• The onset of cardiac issues related to sinus dysfunction occurred after the affected person had obtained 1 week of antibiotic therapy for Lyme disease, the authors state. Due to this fact, “a latest historical past of oral antibiotics shouldn’t be a deterrent to contemplating a Lyme carditis prognosis when clinically acceptable.”
• “Applicable prognosis and therapy of Lyme carditis could also be instrumental for decreasing the danger of pointless cardiac implantable digital system placement…”
• Sufferers who could also be in danger for Lyme disease and are affected by cardiac issues and who exhibit regular ECG findings could profit from distant cardiac monitoring. On this case, sinus dysfunction was recognized with a cellular system.