"Lyme disease should be considered as a potential etiology (cause) for any cardiac abnormality when the patient lives in an endemic area and evidence of another pathogenetic cause is lacking. Evaluation of such patients should include serology studies and further tests as necessary to make a definitive diagnosis of Lyme carditis. Antibiotic treatment follows recommended guidelines."

Source: Lyme Times, Number 10 Publication of Lyme Disease resource Center pg. 33

Original article: Stanek, G. Klein, J, et al.: Borrelia burgdorferi as an Etiologic agent in Chronic Heart failure.

Scandanavian J. of Infectious Disease--Suppl. 77: 85-87, 1991

"Cardiac manifestations of Lyme borreliosis have been described by Steere and others as transient and self-limited. In 1990 Dr. Stanek and colleagues presented a case of isolation of Borrelia burgdorferi from the myocardium of a patient with long standing cardiomyopathy who also had high serum IgG antibodies to Bb (N Eng J Med 1990;322:249-252). The current study was designed to examine an association or even an etiologic role for Bb in this chronic and persistent heart disorder.

"The sera of 72 patients suffering from chronic heart failure due to dilated cardiomyopathy were tested by ELISA for antibodies to Bb. 55 patients with coronary heart disease and 61 healthy blood donors served as controls. 26.4% of the study group were seropositive for antibodies to Bb. Virus serology excluded viral causes of heart disease, and syphilis serology excluded the possibility of serological cross-reactivity. Of the control groups, 12.7 % of patients with coronary heart disease and 8.2 % of the healthy blood donors had IgG antibodies to B. burgdorferi.

"The authors conclude that Bb infection should be considered in the differential diagnosis and etiology of dilated cardiomyopathy."

Gerald Stanek , MD
Hygiene Institute of the University of Vienna
Kinderspitalgasse 15
A-1085 Wien, Austria

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Title:[The cardiac and neurological manifestations of Lyme borreliosis in
congenital first-degree AV block] Authors: Stille-Siegener M, Eiffert H, Vonhof
Source: Dtsch Med Wochenschr 1996 Oct 18;121(42):1292-6
Organization: Abteilung fur Kardiologie, Medizinische Klinik sowie
Hygiene-Institut, Universitat Gottingen.

Abstract:
HISTORY AND CLINICAL FINDINGS: A 19-year-old youth was hospitalized because of sudden onset of incomplete lid closure and drooping mouth on the left. He regularly walked through fields and woods; three weeks before admission he had noted swelling and reddening on his neck, which he thought was due to an insect bite. When 9 years old a functional heart murmur and 1 degree AV block (P-R interval 0.25s) had been found. Physical examination showed peripheral facial paresis and a 2/6 systolic murmur over the aortic area. INVESTIGATIONS: As Borreliosis (Lyme disease) was suspected, relevant laboratory tests were performed. These revealed specific IgM antibodies against Borrelia burgdorferi. Polymerase chain reaction demonstrated B. burgdorferi-specific DNA in cerebrospinal fluid and urine. The ECG showed 1 degree AV block (P-R interval 0.28s).

TREATMENT AND COURSE: Ceftriaxone was administered at once (4g, followed by 2g daily intravenously for 14 days). The P-R interval increased to maximally 0.31 s and transient incomplete right bundle branch block developed on the second day. Long-term ECG monitoring also revealed ventricular arrhythmia's (Lown IVb), but they gradually disappeared. The neurological signs regressed completely within five days of the start of treatment, while the P-R interval had returned to its initial value of 0.25 s 3 months later.

CONCLUSION: The case makes clear that an ECG should be recorded in borreliosis even in the absence of cardiac symptoms. Hospitalization with long-term monitoring becomes necessary if it is abnormal.

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Authors: Vegsundv, Nordeide, jenum,Reikvam
Title: Cardiac Manifestations of Borrelia burgdorferi Infection
Source: Tidsskr Nor Laegeforen 1993 Sept. 30;113(23):2911-2

Abstract:

Lyme borreliosis, caused by the tick-borne spirochete Borrelia burgdorferi, has been found to cause a variety of clinical syndromes including cardiomyopathy, dermatopathy, neuropathy, and arthropathy. Lyme carditis was originally described as a mild self-limited carditis, primarily involving the conduction system. However, recent reports suggest that cardiac involvement may be more serious than previously suspected, and may cause heart failure and probably congestive cardiomyopathy.

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Authors: Klein, Stanek, Bittner, Horvat, Holzinger, Glogar
Title: Lyme borreliosis as a cause of myocarditis and heart muscle disease
Source: Eur Heart J 1991 Aug;12 Suppl D:73-5

Abstract:

Lyme borreliosis is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the joints, heart and other organs. The etiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB were first described, including acute conduction disorders, atrioventricular block, transient left ventricular dysfunction and even cardiomegaly.

Pathohistological examination showed spirochetes in cases of acute myopericarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dilated
cardiomyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia burgdorferi. On Elisa 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease.

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Authors: Vorob'eva, Volegova, Burylovl, Tkachenko, Koz'minykh, Altpova
Title: The clinical picture and course of the nonerythematous form of
ixodid tick-borne borreliosis
Source: Med Parazitol 1995 July-Sep;(3):12-5

Abstract:

The territory of the Perm region is highly endemic in Ixodes (B. garnii and B. afzeli)-borne borreliosis. The clinical manifestations of ERYTHEMA-LESS Ixodes-borne borreliosis were studied in the 1991-1994 epidemiological seasons. A total of 54 patients were examined in the acute stage of infection and 4-6 months later. There were common symptoms of damage to the central nervous system in early infection and pronounced signs of damage to the central and peripheral nervous systems in the late period which was characterized by cardiovascular diseases as disturbances of automatism functions, conduction, diffuse and local muscle changes.

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Authors: Lesniak, Lirman, Antiufev
Title: Heart disorders in Lyme disease
Source: Klin Med 1994;72(1):45-7

Abstract:

The paper presents literature data on clinical manifestations, instrumental diagnosis and pathohistological changes in Lyme carditis. Three cases were analyzed. The emphasis is placed on the necessity of three differential diagnosis with Lyme disease is all cases of unclear myocarditis and cardiac arrhythmia, especially in the territories endemic for tick-borne diseases.

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source: Clinical Manifestations of Lyme Disease in the United States
Connecticut Medicine June 1989; Volume 53, No.6 pg. 327-330
Trock,M.D.,Craft,M.D., Rahn,M.D.

"Cardiac Manifestations"

"Lyme carditis .......may be the initial manifestation of Lyme disease. Fluctuating degrees of atrioventricular block, including first degree heart block and Mobitz type 1 block, including first degree heart block and Mobitz type 1 block, are the most common features of carditis, but may progress to complete heart block requiring a temporary pacemaker. The cardiac conduction abnormalities of Lyme disease are usually brief, lasting days to weeks and generally do not require permanent cardiac pacing. However, one recently described patient had residual Mobitz Type 1 block 16 months after removal of a temporary pacemaker for Lyme carditis.

"Less common cardiac manifestations have included arrhythmia's (supraventricular tachycardia and premature ventricular contractions) and myopericarditis with transient cardiomegaly and left ventricular dysfunction. This latter problem may be mistaken for acute rheumatic fever when cetaceous and joint manifestations are also present. EKG changes in such patients may include diffuse T-wave flattening or inversion, rarely ST segment depression. The diagnosis of Lyme disease should be considered in all cases of unexplained heart block, because it is treatable with antibiotics."

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"......First, we have electrophysiologicaly documented the diffuse nature of the conduction system involvement that can occur in the disease...."

Lyme Carditis - Electrophysiologic and Histopathologic Study
The American Journal of Medicine; Nov. 1986 vol. 81 pg. 923-927
Reznick,D.O., et al (From the Section of Cardiology, Department of
Internal Medicine, and the of Pathology, Chicago College of Oteopathic
Medicine, Chicago, Illinois...)

"....Lyme disease, . The cardiac abnormalities that may result from this disease have been reviewed by Steere et al . The most common cardiac manifestation is a conduction system disturbance with varying degrees of atrioventricular block. Myocarditis has been described on clinical grounds, supported by electrocardiographic changes and radionuclide ventriculographic evidence of mild left ventricular dysfunction. We report herein a case of Lyme disease with biopsy proved myocarditis and possible spirochete identification within the cardiac biopsy specimen. The diffuse nature of the conduction system abnormality, which was the principal feature in this case, was documented electrophysiologically.

................Our case demonstrates several important features of Lyme carditis not previouslyreported.
....First, we have electrophysiologicaly documented the diffuse nature of the conduction system involvement that can occur in the disease..........Our experience suggests that patients with Lyme carditis who exhibit any conduction abnormality require hospitalization and close electrocardiographic monitoring. The rapid progression from 2:1 atrioventricular block to complete heart block with subsidiary pacemaker failure in our patient underscores the need to consider early temporary pacemaker therapy in patients with Lyme carditis, even when the initial conduction abnormality may appear benign........"

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Authors: Hammers-Berggren S, Griondahl A, Karlsson M, von Arbin M,
Carlsson A., Stiernstedt G

Title: Screening for neuroborreliosis in patients with stroke

Source: Stroke 1993 Sept;24(9):1393-6

Abstract: Background and Purpose: Borrelia burgdorfei, the etiologic agent of Lyme disease, can cause different neurological manifestations. We studied the prevalence of Lyme neuroborreliosis in patients with stroke.
.......Conclusions: We conclude that Lyme neuroborreliosis may imitate stroke, but screening for antibodies against B burgdorferi seems to be of little value and may be replaced by a CAREFUL medical history.

Neurology 43(12): 2705-2707 (Dec 1991)
Stroke Due to Lyme Disease
Reik L. Jr.
Department of Neurology, University of Conn. Health Center, Farmington
06030-1845.

A 56 year old Connecticut woman suffered multiple strokes 18 months after antibiotic treatment for early Lyme disease with facial palsy. Pleocytosis, intrathecal synthesis of anti-Borrelia burgdorferi antibody, and the response to antibiotic treatment substantiated the diagnosis of neuroborreliosis. This is the first report of stroke caused by Lyme disease acquired in North America.