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Lyme Carditis: From Pathophysiology to Clinical Management
Cinzia Radesich1, Eva Del Mestre1, Kristen Medo2
1Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, 34127 Trieste, Italy.
Pathogens (Basel, Switzerland)
|May 28, 2022
Summary
Lyme carditis, a rare manifestation of Lyme disease, often causes fluctuating atrioventricular block. Early antibiotics and monitoring are key, as permanent pacemakers are usually not needed for this transient condition.
Area of Science:
- Infectious Diseases
- Cardiology
- Immunology
Background:
- Cardiac involvement in Lyme disease, known as Lyme carditis, is uncommon but significant.
- It frequently manifests as atrioventricular block (AVB), potentially progressing to complete heart block.
- Immune-mediated mechanisms involving Borrelia burgdorferi antigens are suspected in its pathogenesis.
Purpose of the Study:
- To elucidate the pathophysiological basis of Lyme carditis.
- To describe the clinical presentation and diagnostic challenges of Lyme carditis.
- To outline the recommended treatment principles for Lyme carditis.
Main Methods:
- Review of current literature on Lyme carditis.
- Analysis of diagnostic criteria including epidemiology, clinical signs, serology, ECG, and echocardiography.
- Discussion of management strategies, emphasizing monitoring and antibiotic therapy.
Main Results:
- Two-thirds of patients with Lyme carditis may progress to complete atrioventricular block.
- The condition is often transient, making routine permanent pacemaker implantation contraindicated.
- Prompt initiation of antibiotic therapy is crucial for reducing disease duration and complications.
Conclusions:
- Lyme carditis requires vigilant monitoring due to potential rapid progression of AVB.
- Diagnosis relies on a comprehensive approach, excluding other cardiac pathologies.
- Timely antibiotic treatment and temporary pacing, if needed, are central to managing Lyme carditis.
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