What Causes Tachycardia And Intermittent Chest Pain While Having Lyme's Disease?

Posted on Tue, 17 Jan 2017

Question: My 27 year old daughter, who was diagnosed with Lyme disease in 2012, underwent oral antibiotic treatment for Lyme in 2013. When that was unsuccessful, she underwent IV antibiotic treatment for several months, which was discontinued in 2013. During the IV antibiotic treatment, she developed previously unknown symptoms of tachycardia, skipped heart beats, and chest pain, which was intermittent. Despite the antibiotic therapy having been discontinued in 2013, she continues to have these symptoms intermittently, which are often brought on by either mild physical activity (such as walking or climbing stairs) or emotional stress/anxiety. She has had a full cardio workup by a cardiologist, i.e. EKG, holter monitor for several days, and echocardiogram, all normal. Her cardiologist continues to monitor her but does not believe her symptoms reflect a heart condition, and instead believes that they relate to her Lyme disease. I recently read that there is a documented relationship between certain antibiotics, including ones that she took, and tachycardia. I am now wondering whether this is the source of the problem, and, if so, whether there is any known treatment or possible recommendation for treatment given that she continues to have these symptoms three years after discontinuing the antibiotics.

Answered by Dr. Dr Sameer Maheshwari (5 hours later)

Brief Answer:
It is because of Lyme disease only

Detailed Answer:
Hi,
This is Dr Sameer, cardiologist.
I wish a good health for your daughter.
The symptoms you are telling looks only because of Lyme Disease. Antibiotics can cause tachycardia & palpitation which is transient & gets relieved after stopping it.
Only Some medicines like Chemotherapy agents can cause permanent damage to the heart(which your daughter has not taken) & that too us seen on Echo. If echo is fine the symptoms are due to Lyme disease only.

The Lyme bacterium can infect all parts of the heart, including the conduction system, the outer or inner membranes of the heart, the cardiac muscle, and more rarely, cardiac blood vessels or heart valves. The predominant cardiac manifestation is partial heart block caused by impairment of the electric signal that controls contraction of the upper and lower chambers of the heart. Heart block usually is mild, with complete resolution within 6 weeks after onset. The most common symptoms are light-headedness, fainting, shortness of breath, palpitations, and/or chest pain. Heart block occasionally is complete and permanent.

I hope this was helpful to you.
Wishing your daughter a lots of love & early recovery.
Regards
Dr Sameer Maheshwari

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr Sameer Maheshwari (13 hours later)

Thank you, Dr. Maheshwari. I understand that heart block is another name for Lyme Carditis. My daughter's cardiologist thought it was unlikely that this was the cause of her symptoms, as, according to him, Lyme Carditis typically occurs shortly after the Lyme infection, i.e. weeks or months at most. Although my daughter was not diagnosed has having Lyme until 2012, she had symptoms consistent with Lyme for about 10 years before then, and her diagnosis followed two years of tests that were prompted by severe symptoms that began in 2010. Based on that, her cardiologist felt that the heart issues, which first arose in 2013, were not an indication of Lyme Carditis. Also, it is my understanding that the electrical interference from Lyme Carditis would show up on an ECG. Is that correct? She has had several ECG's in the past three years, all normal. I read that Lyme Carditis can by asymptomatic initially. Is that true? If so, is it possible that she did have it for years but no symptoms until 2013? Would that be consistent with a normal ECG? If you do believe that her symptoms are most consistent with Lyme Carditis, would that mean that it is only a coincidence that the symptoms first arose when she was receiving IV antibiotics?

Also, I read an article on Lyme Carditis after receiving your response (the cite is Infect Dis Clin N Am 22 (2008) 275–288), which contains the following statement: "There is evidence that autoimmunity may play a role in Lyme carditis, and that antibodies directed toward B burgdorferi react with myosin. This was shown in a murine model of autoimmunity and suggested that persistent symptoms among some patients with underlying autoimmune disorders may not be caused by persistent infection." Have you ever heard of the symptoms that I have described for my daughter being caused by this sort of autoimmune response?

Answered by Dr. Dr Sameer Maheshwari (11 hours later)

Brief Answer:
Please see detailed answer

Detailed Answer:

Hi,
Welcome back. Sorry for the delayed reply. You are really a amazing mother who is searching & doing so much for her daughter. I respect you madam.

Now coming to your queries. Let me explain you Lyme's carditis in detail.
Lyme's carditis is relatively less studied subject & has less reference. It typically occurs 3 weeks after the erythema(skin rash). When lyme's organism(B.Burgdoferri) reach the blood circulation our body immune system activate & forms antibodies against it. These antibodies has tropism(similarity or affinity) to our body organs like nervous system, joints & heart muscle causing Lyme's carditis. So yes it is a autoimmune response.
90% of patients with Lyme's carditis have ECG changes in the form of heart block. 15% patients can have tachycardia.
The ECG changes of Lyme's carditis is completely reversible in 6weeks. In some cases patients develop weakening of heart muscles which can be easily seen on echo. Also bases on current data their correlation is very hard to explain.

So considering such a long time, it is not possible for Lyme disease to cause these tachycardia. Also echo & ECG are normal which rules out any other abnormality.
As i said earlier also tachycardia caused by antibiotics are short lasting & goes away when drug is eliminated from the body.
One other explanation for such tachycardia is that she is having these symptoms when she is in stress, which is a normal phenomenon & a normal body response.
So i recommend to keep monitoring her & hope she will remain absolutely fine.
I wish a good health for her.
I hope i have cleared your queries. If you have any further, feel free to contact.
Regards
Dr Sameer Maheshwari

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr Sameer Maheshwari (16 hours later)

Hi Dr. Maheshwari,

Thank you very much for your response to my follow-up questions. I want to make sure I understand what you are saying. It appears that you do not believe that my daughter has Lyme Carditis, both because of her normal ECGs and because of the time that elapsed from the onset of her Lyme symptoms and the onset of her heart symptoms. However, assuming that is the case, do you think it may be possible that the antibodies that were created by her body's initial response to the Lyme organism could still remain in her body now? And if so, could those antibodies be responsible for triggering her heart symptoms now, years after her original Lyme symptoms appeared, even if it is not Lyme Carditis?

If you do not think that is possible, then it appears that you do not believe that her heart symptoms have any relationship with her Lyme, but rather they are instead simply triggered by stress. Is that correct? If so, do you have any suggestions for treatment, other than typical methods for reducing stress?

Thank you.

Answered by Dr. Dr Sameer Maheshwari (4 hours later)

Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back. No case of Lyme's carditis with ECG changes after so much time of Lyme's carditis has been seen in literature. The antibodies disappear after 6weeks. Only long term problem is cardiomyopathy(weakening of heart muscles), which can be easily seen on echo.
The definitive diagnosis of Lyme's carditis can only be made by cardiac biopsy. I don't this doing this is a good idea for your daughter & it carry a very high risk.
So don't worry. Just keep monitoring her.
Stress increases the sympathetic response of our body & increase heart rate. Apart from typical stress medicine we also give beta blocker which block this sympathetic response & control heart rate. It requires bp monitoring as it decrease the bp also.
I hope this was helpful.
If you have any further queries I'll always be available.
Regards
Dr Sameer Maheshwari

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Dr Sameer Maheshwari (15 hours later)

Thanks, Dr. Maheshwari,your insights are very helpful. One thing I do want to emphasize is that her heart symptoms are not just triggered by stress. Physical activity, as light as walking on a treadmill or going up stairs, can trigger it, and she often has the problem shortly after eating food (particularly but not exclusively sugary foods), as though digestion was a trigger. Also, she often describes the feeling as an adrenaline rush that she can't calm down. (As a result, she spends most of her time sitting quietly, trying not to trigger the symptoms.) Do you think she should consult with an endocrinologist or some other specialist?

Answered by Dr. Dr Sameer Maheshwari (17 minutes later)

Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back.
No tachycardia is induced by digestion. It must just be a coincidence or she might be too anxious in personality. Feeling of Adrenal rush also points towards that direction. Try to calm her down or she might need a councelling for that. As i told you earlier also beta blocker are medicine that blocks the sympathetic pathway. That can be given but in case her bp response is fine with that as these decreases bp too.
It also does not look like a endocrine disorder but still i would recommend for at least a Ultrasound of abdomen & a test called 24hr urinary VMA, as in our abdomen we have a gland called suprarenal or adrenal gland & its increased secretion can cause palpitations, anxiety, tachycardia. So that is the test we can do to know if their is any abnormality causing it or it is just a normal response of her body to stress. Also know that stress can be of both kinds- physical & mental which can cause tachycardia.
I hope i was helpful in clearing your doubts. If you have any further, I'll always be available.
Regards
Dr Sameer Maheshwari

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Raju A.T