A boy with severe cardiac Lyme disease. An Inside Lyme Podcast.

I will be discussing a 15-year-old boy with severe cardiac Lyme disease in this Inside Lyme podcast.

Nawrocki and his colleague first discussed this case in the Air Medical Journal  in 2018.

A 15-year-old boy experienced an episode of exertional syncope while at a trampoline park. Syncope is a temporary loss of consciousness.

He had a history of an attention-deficit/hyperactivity disorder.

His friends immediately called 911. They were not sure how long he was unconscious.

The boy was pale with a heart rate of 300 beats per minute, according to the medics. His EKG showed a wide complex tachyarrhythmia. That means that the heart is fast, and the QRS parts of his EKG were wide.

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He was given a dose of amiodarone, but the ventricular tachycardia remained a problem. Amiodarone is a medicine used to treat and prevent irregular heartbeats.

At the hospital, he was dizzy and was short of breath. His heart rate remained between 290 and 300. His blood pressure dropped to 66/30 mm Hg.

He required synchronized cardioversion. Synchronized cardioversion is a procedure similar to electrical defibrillation. Synchronized cardioversion uses low energy synchronized with the heart.

His EKG changed to a third-degree heart block. That occurs when there is a complete block of impulses from the atrium to the ventricle. The atrium is the top of the heart, and the ventricle is the bottom. He had pacing pads placed.

He was flown to a cardiac intensive care unit (ICU) at a children’s tertiary care hospital via rotary-wing aircraft staffed with two flight nurses.

He continued to have a complete heart block with a fast rhythm.

Cardiac Lyme disease

Doctors suspected Lyme disease and prescribed intravenous ceftriaxone. The diagnosis of Lyme disease was confirmed by “anti-Lyme titers” and Western blot tests.

His low heart rate and low pressure continued. The doctors inserted a transvenous pacemaker to control the heart rate.

He had three additional episodes of ventricular tachycardia. He was cardioverted twice.

But after several days of intravenous antibiotics, the boy’s heart block gradually resolved, and the pacemaker was removed.

He completed 28-days of IV treatment. He remains well on a one-year follow-up, according to the authors.

The authors note that conduction problems have been reported previously in untreated Lyme disease. The list of conduction abnormalities includes first and second-degree AV block, ST and T wave changes, prolonged QT, junctional tachycardia, and complete heart block.

There was no mention of conduction problems in patients who have been treated. I have not seen conduction problems in patients I have treated.

What can we learn from this case?

1. Cardiac Lyme disease or more commonly known as Lyme carditis, can lead to life-threatening rhythm disturbances.
2. The conduction problems with cardiac Lyme disease can rapidly change.
3. Antibiotic treatment was helpful.
4. A pacemaker was necessary in this case. The doctor was able to remove the pacemaker after treatment with antibiotics.

What questions does this case raise?

1. How often does cardiac Lyme disease occur?
2. Are there cases of cardiac Lyme disease cases that are not diagnosed?
3. Were there any warning signs of cardiac Lyme disease that would have allowed treatment before the young man collapsed?
4. Would the doctors have been able to recognize cardiac Lyme disease early before the need for hospitalization, air transport, and cardioversion?

Treating Tick-Borne Disease In My Practice

In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills recognizing Lyme carditis. We hope that professionals evaluating individuals with Lyme carditis can use this case to remind them to look for tick-borne illnesses and treat accordingly.