Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States
Synopsis: Symptomatic infection of the heart is rare in recognized Lyme disease cases and usually resolves promptly with appropriate antibiotic therapy. Nonetheless, cardiac involvement occasionally can cause life-threatening cardiac conduction abnormalities. During November 2012–July 2013, one woman and two men (ranging in age from 26 to 38 years) from high-incidence Lyme disease states experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis. Donated corneas from two decedents had been transplanted to three recipients before the diagnosis of Lyme disease was established, but no evidence of disease transmission was found. Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions.
What are the implications for public health practice?
Pathologists and medical examiners should be aware that Lyme carditis can be a cause of sudden cardiac death. All suspected cases of fatal Lyme carditis should be reported to state or local public health authorities, and the cases should be investigated. Physicians and health-care providers should ask patients with suspected Lyme disease about cardiac symptoms, and conversely, ask patients with acute, unexplained cardiac symptoms about possible tick exposure and symptoms of Lyme disease. Clinicians should encourage all patients to practice recommended tick bite prevention strategies.
Commentary: Three deaths were recently reported from heart inflammation due to Lyme disease. Fatal Lyme carditis is rare, but recent case reports outline the need to heighten screening and treatment for tick-borne infections, especially in patients with new and acute cardiac symptoms. I have only seen a handful of cases with 3rd degree heart block during the last 26 years, and they all favorably responded to antibiotic therapy, avoiding the need for a permanent pacemaker.