2020 Jan 25;59:65-67. doi: 10.1016/j.jelectrocard.2020.01.007. [Epub ahead of print]

Lyme carditis presenting as sick sinus syndrome.


Lyme disease, a tickborne infection caused by Borrelia burgdorferi, can affect cardiac tissue causing Lyme carditis. Patients with Lyme carditis most commonly present with varying degrees of atrioventricular block and rarely with sick sinus syndrome. A previously healthy 22 year-old male presented with syncope (fainting). His 2 week Holter monitor showed sinus pauses of 6.5 and 6.8 s. Lyme serology, including Western blot, was positive. A stress test, completed after 8 days of intravenous antibiotics for Lyme carditis, revealed no conduction abnormalities. He was discharged on 3 weeks of oral antibiotics and had no conduction abnormalities on subsequent follow-up.



I hope someone is doing a lengthy follow-up on this young man.  Three weeks of antibiotics in someone with Lyme carditis isn’t enough.  This is a great example of patients not being followed throughout time which would pick up reoccurring/relapsing symptoms.

Sick sinus syndrome doesn’t have anything to do with the sinuses, but rather consists of a group of heart rhythm problems (arrhythmias) in which the heart’s natural pacemaker (sinus node) doesn’t work properly.

The sinus node is an area of specialized cells in the upper right chamber of the heart that controls the rhythm of your heart. Normally, the sinus node produces a steady pace of regular electrical impulses. In sick sinus syndrome, these signals are abnormally paced.


The heart rhythms of a person with sick sinus syndrome can be too fast, too slow, punctuated by long pauses — or an alternating combination of these rhythm problems. The syndrome is relatively uncommon, but the risk of developing it increases with age.

Many people with sick sinus syndrome eventually need a pacemaker to keep the heart in a regular rhythm.


Most people with sick sinus syndrome initially have few or no symptoms. In some cases, symptoms come and go.

When they occur, sick sinus syndrome signs and symptoms might include:

  • Slower than normal pulse (bradycardia)
  • Fatigue
  • Dizziness or lightheadedness
  • Fainting or near fainting
  • Shortness of breath
  • Chest pains
  • Confusion
  • A sensation of rapid, fluttering heartbeats (palpitations)

Dr. Neil Spector writes about his heart troubles due to Lyme.  He required a heart transplant and pace-maker:

For more:  Course for doctors to become educated.

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