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CDC: 3 cardiac deaths tied to Lyme carditis
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From November 2012 to July 2013, there were three occasions of cardiac deaths associated with Lyme carditis, the CDC reported in MMWR.
“Medical examiners and pathologists should be aware that Lyme carditis is a potential, albeit rare, cause for sudden cardiac death in persons from high-incidence Lyme disease areas,” the investigators wrote.
The three cases, two men and one woman, were from Massachusetts, Connecticut and New York, all of which are known for a high incidence of Lyme disease. Most of the 30,000 confirmed and probable cases of Lyme disease reported in the United States in 2012 were in the high-incidence states, which also include Delaware, Maine, Maryland, Minnesota, New Hampshire, New Jersey, Pennsylvania, Rhode Island and Wisconsin.
The first death was a Massachusetts resident in November 2012. The patient had no serious pre-existing medical conditions, but relatives reported the patient described malaise and muscle and joint pain in the 2 weeks prior to death. Microscopic examination of cardiac tissue identified extensive myocarditis with mixed perivascular lymphoplasmacytic inflammation. Postmortem serum tests by the CDC identified findings consistent with disseminated Lyme disease.
The second death was a New York resident in July. The patient’s medical history included Wolff-Parkinson-White syndrome. There was evidence of hypertensive and atherosclerotic cardiovascular disease found at autopsy. Examination of cardiac tissue identified moderate diffuse, perivascular lymphoplasmacytic pancarditis. Serologic testing was consistent with recent infection with Borrelia burgdorferi.
The third death was a Connecticut resident in July who collapsed while visiting New Hampshire. Within 7 to 10 days before death, the patient had complained of shortness of breath and anxiety. The autopsy revealed myocarditis, and examination of heart tissues revealed diffuse mixed perivascular lymphoplasmacytic pancarditis. B. burgdorferi were found in the myocardium.
“Prompt recognition and early, appropriate therapy for Lyme disease is essential,” the researchers wrote. “Health care providers should ask patients with suspected Lyme disease about cardiac symptoms and obtain an EKG if indicated.”
Perspective
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Eugene Shapiro, MD
Lyme carditis is extremely rare, and I don’t think this report is necessarily a cause for alarm. There have been very few cases reported throughout the world in the past 30 years. It doesn’t have any implications for the public-at-large, but physicians should keep it in mind as a rare cause of sudden death or syncope, especially in Lyme endemic areas. It also highlights the need for prevention and early detection and treatment of Lyme disease.
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