Lyme Disease and Pericarditis

Cardiac Manifestations of Lyme Disease

Cardiac involvement occurs in approximately 4-10% of all patients with Lyme disease 1
Cardiovascular manifestations typically occur within 2 months after the initial infection, often within 21 days of exposure 1
Lyme carditis frequency appears to be lower in more recent studies, possibly due to earlier recognition and treatment of erythema migrans 1

Symptoms may include chest pain, dyspnea, palpitations, syncope, lightheadedness, and exercise intolerance 2, 3
Pericarditic pain, evidence of pericardial effusion, and elevated cardiac biomarkers may be present 2, 3
ECG should be performed in patients with signs or symptoms consistent with Lyme carditis 2, 3
In patients with acute myocarditis/pericarditis of unknown cause in an appropriate epidemiologic setting, testing for Lyme disease is strongly recommended 2, 3
In the absence of concomitant erythema migrans, serologic confirmation is necessary 1

For patients with Lyme carditis including pericarditis, antibiotic therapy for 14-21 days is recommended 1, 2
For hospitalized patients with Lyme carditis, initial IV ceftriaxone is suggested until clinical improvement, then switching to oral antibiotics to complete treatment 2, 3
For outpatients with Lyme carditis, oral antibiotics may be sufficient 2, 3
Oral antibiotic options include doxycycline, amoxicillin, cefuroxime axetil, and azithromycin 2, 3
Hospitalization and continuous ECG monitoring are recommended for patients with clinical manifestations of myopericarditis 2, 3

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