Doctors do need to have a higher index of suspicion when a young person comes in with unusual heart symptoms - Dr. Michael Smith
image by: Physiotherapy Foundation Of Bangladesh
Usually a manifestation of an underlying systemic infectious or inflammatory condition, carditis, once a common complication of rheumatic fever can be associated with Lyme disease...
Early last spring, Hannah Sowers noticed she was having trouble keeping up with her track teammates and even when she was relaxing; her heart was doing acrobatics in her chest.
"I noticed my heart would speed up fast and then stop and give one big squeeze and then start up. It felt really odd," said the 20-year-old Monaghan Township college junior. She mentioned it to her family, but since she didn't have any other symptoms and "weird heart palpitations" run in their family, she didn't pursue it.
When it started to happen more frequently - up to 25 times a day - Sowers went to her family doctor, who fitted her with a Holter monitor for 24 hours to monitor her heart's rhythm. To her surprise, it showed a second degree heart block, which meant the heart was skipping beats for some reason. Sowers, a certified nursing assistant at Select Specialty Hospital in Camp Hill, was at work when the doctor's call came with the news.
Further testing revealed the surprising culprit behind Sowers' heart problem: Lyme disease. Sowers was put on a month of doxycycline, the standard treatment for Lyme disease, and her heart symptoms began to decrease. The condition is expected to completely resolve.
"I was concerned that it was a heart condition and it was going to keep me from competing or that I'd need surgery or need to be on some heart medication for the rest of my life," said Sowers, who had been brought to her knees from chest pain earlier that day at work.
Other Lyme disease symptoms may be lacking. "I usually see Lyme carditis -- inflammation of the heart -- two to three times a year, when I have young people coming in with an atrioventricular block and it turns out to be Lyme," said Dr. Michael Smith, a cardiologist with PinnacleHealth Cardiology in Wormleysburg.
In his experience, Lyme carditis often occurs in the absence of hallmark Lyme symptoms such as rash or joint pain. Sometimes, the condition causes third-degree or complete heart block, which means electrical impulses don't pass from the top to the bottom chambers of the heart at all.
Usually Lyme carditis resolves within a week of medication, Smith said, although patients sometimes need intravenous antibiotics. "I have had cases where, after several days of IV antibiotics, symptoms haven't improved, and I have had to put in a temporary pacemaker to get the heart pumping effectively," Smith said.
Though Lyme carditis occurs in only about 5 to 10 percent of all Lyme cases, it's something doctors should look for if a young person comes in with heart problems, because Lyme is prevalent in the midstate, Smith said.
Dr. John Goldman, infectious disease specialist with PinnacleHealth System in Harrisburg, said people need to remember that Lyme disease can have different symptoms. "It is an unusual presentation of Lyme disease, but it's usually caught before it gets to a complete heart block," he said. "The thing about Lyme disease is that it can present very non-specifically, with a classic bull's eye rash or a different rash or flu-like symptoms or no symptoms."
Lyme carditis can be very dangerous because, if people progress to a complete heart block, their blood pressure may go too low or they may suddenly faint, perhaps while driving or doing some other activity, Goldman said. "Doctors do need to have a higher index of suspicion when a young person comes in with unusual heart symptoms. They should be checking for Lyme, which is prevalent in our area," Smith said.
Pennsylvania remains No. 1 in the nation for confirmed cases of Lyme disease, with 4,981 cases in 2013, up from 4,146 cases in 2012, according to the Centers for Disease Control. Chester County leads the pack with 489 cases in 2013. Some 45 counties recorded an increase in confirmed cases in 2013, according to the Pennsylvania Department of Health. Lyme disease is especially prevalent in York County, which reported 219 cases in 2013. Dauphin County had 119 cases and Cumberland County saw 83 cases in 2013, according to the Department of Health.
"In Pennsylvania, where we have Lyme disease now documented in every county, anyone with a rash, summer flu-like symptoms, a Bell's palsy, which is a droop in one side of the face, or anything that looks like a heart block, should get a Lyme test," Goldman said.
However, if patients present with a fever or Lyme rash, doctors should go ahead and treat for Lyme disease before running the test because, at that point in the presentation, the test will come back falsely negative half the time, Goldman said.
Most cases of Lyme disease can be successfully treated with 14 to 28 days of an antibiotic, such as doxycycline, which also usually successfully treats accompanying tick-borne diseases, he said.
Sowers said she was shocked to learn her heart problem was caused by Lyme disease. "I live in the woods, but I hadn't seen a tick on me or had any rash or symptoms of Lyme disease," said Sowers, who was relieved to have a diagnosis that will not impede her involvement on the track and field team at Messiah College, where she is a nursing major.
Source: Carolyn Kimmel, When a young person suddenly develops heart problems, think Lyme disease, PennLive, August 1, 2015.