Cardiac implications of Lyme disease, diagnosis and therapeutic approach

Lelovas, Pavlos; Dontas, Ismene; Bassiakou, Eleni; Xanthos, Theodoros

doi:10.1016/j.ijcard.2008.01.044

Cited by 69 publications

(72 citation statements)

References 65 publications

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“…Cardiovascular manifestations usually occur within the first 21 days of exposure to the agent (Lo et al, 2003;Nalmas et al, 2007) and as long as nine months after the onset of disease (Bateman and Sigal, 2000), which is in fitting with our case that had AF, cardiomegaly and decreased SF approximately two months after the onset of neuro-orthopedic signs. The relationship between (2006) heart disease and borreliosis, as established in this clinical case is based on serologic tests and the clinical diagnosis (Lamaison, 2007;Lelovas et al, 2008). Generally, a positive Lyme titre and cardiac clinical signs are present concurrently.…”

Section: Discussionmentioning

confidence: 91%

“…It is unknown why some patients develop cardiac symptoms as well as cardiac signs of inflammation, while others do not; however, it is believed that susceptibility could be multifactorial. Many cases of borrelial DCM are believed to be caused by infectious myocarditis, direct tissue invasion by the infectious agent, genetic susceptibility, type of borrelial strain, release of cardiotoxic substances by the microorganism (Herxheimer-Jarisch reaction) and activation of autoimmune processes (Gasser et al, 1999;Saba et al, 2001;Lelovas et al, 2008). There is a positive correlation between spirochetal load and loss of cardiomyocytes which suggests that spirochetes or their products are responsible for the loss of cardiomyocytes, through their ability to induce production of cytokines by macrophages and activate endothelial and other host cells (Londono et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

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Cardiac manifestations of borreliosis in a dog: a case report

Agudelo¹,

Schánilec²,

Kybicová³

et al. 2011

Vet. Med. - Czech

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ABSTRACT:In Europe Lyme disease is caused by the spirochete Borrelia burgdorferi sensu lato. It presents with a variety of clinical manifestations including heart disease and problems of the nervous system, skin and joints. Lyme carditis occurs in 4-10% of infected humans and is characterized by a plethora of cardiovascular syndromes such as arrhythmia, myocarditis, and pericarditis among others. This article is a case report of a serologically positive (B. burgdorferi s.l.) dog, in which the antibody dynamics correlated with clinical, electrocardiographic, and echocardiographic findings of heart disease resembling human Lyme-induced dilated cardiomyopathy (DCM). Keywords: borreliosis; atrial fibrillation; serology; cardiomegaly; dogsList of abbreviations AF = atrial fibrillation; ALP = alkaline phosphatise; ANA test = antinuclear antibody test; AV = atrioventricular; BID = twice daily; CBC = complete blood count; CDCD-VFU = Clinic of Dog and Cat Diseases, University of Veterinary and Pharmaceutical Sciences, Brno; DCM = dilated cardiomyopathy; DNA = deoxyribonucleic acid; ECG = electrocardiography; IgG = Immunoglobulin G; IgM = Immunoglobulin M; PCR = polymerase chain reaction; SF = shortening fraction; SID = once daily; TBE = tick-borne encephalitis; TID = three times daily; VHS = vertebral scale size

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Cardiac manifestations of borreliosis in a dog: a case report

Agudelo¹,

Schánilec²,

Kybicová³

et al. 2011

Vet. Med. - Czech

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“…northeast and north-central USA) [1,2]. Although Lyme carditis (LC) is an uncommon manifestation of the early disseminated phase (weeks to months after a tick bite), it can present with various degrees of atrioventricular (AV) blocks, and if not promptly treated can be fatal [3]. We hereby present a case of completely reversed third-degree AV block due to Lyme disease.…”

Section: Introductionmentioning

confidence: 99%

Rapid complete atrioventricular heart block reversal due to Lyme carditis

Bourji

Newsome

Meyerhoff

2018

Journal of Community Hospital Internal Medicine Perspectives

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“…Lyme carditis is a rare manifestation, occurring in 1.5%–10% of cases in North America and 0.5%–4% in Europe [2]. Whereas there is no sex predisposition for Lyme disease, Lyme carditis has been reported to have a 3:1 male: female ratio [3].…”

Section: Introductionmentioning

confidence: 99%

“…First and second degree heart block are present in 12% and 16% of patients, respectively [3]. B. burgdorferi has also been isolated from the myocardium [6]; this could explain why Lyme disease associated myocarditis may present with cardiac manifestations such as episodes of non-sustained ventricular tachycardia, ST segment depression, reversible depression of left ventricular function and congestive heart failure [2]. …”

Section: Introductionmentioning

confidence: 99%

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction

Gilson

Khalighi

Elmi

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1 mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL. The patient underwent cardiac catheterization which did not show any significant obstructive coronary artery disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome. Abbreviations AV: Atrioventricular; CK-MB: Creatinine Kinase-MB; EKG: Electrocardiogram; ELISA: Enzyme-Linked Immunosorbent Assay; IgG: Immunoglobulin G; IgM: Immunoglobulin M

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Cardiac implications of Lyme disease, diagnosis and therapeutic approach

Cited by 69 publications

References 65 publications

Cardiac manifestations of borreliosis in a dog: a case report

Cardiac manifestations of borreliosis in a dog: a case report

Rapid complete atrioventricular heart block reversal due to Lyme carditis

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction

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