Lyme Disease and Pericarditis
Yes, Lyme disease can cause pericarditis, though it is a relatively rare cardiac manifestation compared to the more common atrioventricular heart block associated with Lyme carditis. 1, 2
Cardiac Manifestations of Lyme Disease
Common Cardiac Manifestations
- Atrioventricular (AV) heart block of varying degrees (first, second, or third-degree) is the most common cardiac manifestation, occurring in up to 90% of patients with Lyme carditis 3
- Myopericarditis occurs in approximately 60% of patients with Lyme carditis 3
- Pericarditis with pericardial effusion is a rare but documented manifestation 2, 4, 5
Epidemiology and Timing
- Cardiac involvement occurs in approximately 4-10% of all patients with Lyme disease 1, 3
- Cardiovascular manifestations typically occur within 2 months after the initial infection, often within 21 days of exposure 1, 6
- Lyme carditis frequency appears to be lower in more recent studies, possibly due to earlier recognition and treatment of erythema migrans 1
Diagnosis of Lyme Pericarditis
Clinical Presentation
- Symptoms may include chest pain, dyspnea, palpitations, syncope, lightheadedness, and exercise intolerance 1
- Pericarditic pain, evidence of pericardial effusion, and elevated cardiac biomarkers (such as troponin) may be present 1
Diagnostic Approach
- ECG should be performed in patients with signs or symptoms consistent with Lyme carditis 1
- Serologic testing for Borrelia burgdorferi antibodies is essential, though early-phase ELISA may be negative 3
- In patients with acute myocarditis/pericarditis of unknown cause in an appropriate epidemiologic setting, testing for Lyme disease is strongly recommended 1
- Cardiac MRI can help confirm the diagnosis and monitor the patient's subsequent course 3
Important Considerations
- Pericarditis may be the only clinical manifestation of Lyme disease in some cases, without preceding erythema migrans 4
- Other more common causes of pericarditis should be excluded 2
- In the absence of concomitant erythema migrans (present in up to 85% of cases), serologic confirmation is necessary 1
Treatment of Lyme Pericarditis
Antibiotic Therapy
- For patients with Lyme carditis including pericarditis, antibiotic therapy for 14-21 days is recommended 1
- For hospitalized patients with Lyme carditis, initial IV ceftriaxone is suggested until clinical improvement, then switching to oral antibiotics to complete treatment 1
- For outpatients with Lyme carditis, oral antibiotics may be sufficient 1
- Oral antibiotic options include doxycycline, amoxicillin, cefuroxime axetil, and azithromycin 1
Monitoring and Additional Management
- Hospitalization and continuous ECG monitoring are recommended for patients with clinical manifestations of myopericarditis 1
- Pericardiocentesis may be necessary in cases with significant pericardial effusion 2
- Most cardiac manifestations of Lyme disease are reversible with appropriate antibiotic therapy 6, 3
Prognosis
- The prognosis of Lyme carditis, including pericarditis, is generally favorable when treated according to current guidelines 3
- Cardiac conduction disturbances are usually reversible with appropriate antibiotic therapy 3
- There is no clear evidence for an association between Lyme disease and later development of dilated cardiomyopathy 3
Important Caveats
- Pericarditis due to Lyme disease is likely underdiagnosed, especially when it occurs without the typical erythema migrans rash 4
- In endemic areas, Lyme disease should be considered in the differential diagnosis of acute pericarditis of unknown etiology 2, 4
- While severe or fulminant congestive heart failure is not typically associated with Lyme disease, pericarditis with effusion can occur and may require specific management 1, 2