Archive for the ‘Heart Issues’ Category

Broad Range of Presentations For Lyme Carditis Cases

https://danielcameronmd.com/broad-range-of-presentations-for-lyme-carditis-cases/

BROAD RANGE OF PRESENTATIONS FOR LYME CARDITIS CASES

In their article “Risk factors for Lyme Carditis: A case-control study,” published in Preventive Cardiology, researchers from Stony Brook University Hospital described a wide range of Lyme carditis cases seen between 2010 – 2016.¹ Out of 247 patients admitted for Lyme disease, 18 met the inclusion criteria for Lyme carditis.

“[Lyme carditis] is caused by direct invasion of myocardial tissue by spirochetes and an immunological host response causing lymphocyte inflammation,” writes Marcos.¹

Furthermore, “B. burgdorferi has a predisposition to cause inflammation of the atrioventricular (AV) node resulting in variable conduction abnormalities.”

The 18 patients with possible Lyme carditis were predominantly Caucasian males with a mean age of 44.5 years (range was 24-79).

All of the patients met the CDC surveillance case definition for Lyme disease. One patient had an erythema migrans (EM) rash with negative blood tests.

The remaining 17 individuals had 2-3 IgM specific bands for Lyme disease. Of these, 5 presented with an EM rash and 11 had 5 or more IgG bands, explains Marcos.

“The most common symptoms at presentation were chest tightness, dizziness, and dyspnea on exertion and symptoms had been present for 4-30 days,” writes Marcos.

The 18 patients exhibited a wide range of abnormal EKG findings:

4 – AV block (2nd and 1st degree AV block)
6 – Right bundle branch conduction abnormalities
2 – New onset of atrial fibrillation
3 – T wave inversion
1 – Sinus bradycardia with ST elevation
2 – Prolonged QT interval

The authors were not able to address the outcome as the study was retrospective.

Marcos and colleagues were able to find a growing number of Lyme carditis cases in the literature. The most common presentation involved atrioventricular conduction abnormalities. Others included: right bundle branch block (RBBB), left bundle branch block (LBBB), widening of the QRS complex, AV dissociation, atrial fibrillation, ventricular dysfunction, fulminant myocarditis, and cardiac arrest.

“The spectrum of ECG abnormalities in [Lyme disease] may be broader than that previously suspected,” the authors conclude. “Clinicians should be aware of these ECG abnormalities that may be a sign of [Lyme carditis] in hyperendemic areas.”

References:
  1. Marcos LA, Castle PM, Smith K, Khoo T, Morley EJ, Bloom M, Fries BC. Risk factors for Lyme carditis: A case-control study. Eur J Prev Cardiol. 2019 Sep 19:2047487319876046.

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For more:  https://madisonarealymesupportgroup.com/2019/11/29/increasing-burden-of-lyme-carditis-in-united-states-childrens-hospitals/

https://madisonarealymesupportgroup.com/2019/02/21/diagnosis-treatment-of-lyme-carditis/

https://madisonarealymesupportgroup.com/2019/11/04/suspect-lyme-carditis-start-empiric-antibiotics-case-report-suggest-and-lyme-carditis-is-not-rare/

https://madisonarealymesupportgroup.com/2018/07/09/with-unexpected-death-autopsies-should-look-for-lyme-carditis/

Excerpt:  “Lyme expert Dr. Daniel Cameron has done a nice job of summarizing five cases in a blog. http://danielcameronmd.com/autopsy-study-reviews-cases-due-to-sudden-cardiac-death-from-lyme-disease/
Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. (March 2016)
http://ajp.amjpathol.org/article/S0002-9440(16)00099-7/abstract
Excerpt:

Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients.”

https://madisonarealymesupportgroup.com/2019/05/15/lyme-carditis-presenting-as-atrial-fibrillation/

https://madisonarealymesupportgroup.com/2018/02/22/new-lyme-cme-course-available-lyme-carditis-more-than-blocked-beats/

https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/

 

 

Patients Can Die When Lyme Carditis Is Not Treated

https://danielcameronmd.com/patients-die-lyme-carditis-not-treated/

PATIENTS CAN DIE WHEN LYME CARDITIS IS NOT TREATED

Lyme carditis can cause a broad range of symptoms. Patients may initially appear to have only a flu-like illness, however the severity of symptoms can change rapidly. In the article “Fatal Lyme carditis in New England: Two case reports,” Marx and colleagues highlight the importance of early recognition and treatment, even empirically, as Lyme carditis can be deadly when left untreated.

“Death can occur when Lyme carditis is untreated,” writes Marx, from the Centers for Disease Control and Prevention (CDC), in the Annuals of Internal Medicine. “Before this report, only 9 fatal cases were reported in the literature.”

Case 1: Waiting for infectious disease appointment

“A 57-year-old man from Vermont presented to a primary care physician after 1 week of fever, fatigue, shortness of breath, and chest pain,” writes Marx.

The evidence for Lyme disease included a disseminated erythema migrans rash, heart block, and a positive Lyme ELISA and IgM Western blot test. Yet, the patient was not treated.

Eight days later, the man presented to an emergency room with worsening symptoms. Physicians suspected Lyme disease, but antibiotics were not prescribed. Instead, a consultation with an infectious disease doctor was scheduled. Unfortunately, it never happened.

Only 12 days after his “initial presentation and before his scheduled appointment, the patient was found unresponsive,” writes Marx.

Case 2: Before the first dose of antibiotics

“A 49-year-old woman from Massachusetts presented to an emergency department with severe headache, nausea, and vomiting,” writes Marx. She was diagnosed and treated for a headache.

“Two weeks later, she saw her primary care physician and reported 2 episodes of syncope with bowel and bladder incontinence, persistent fatigue and nausea, and shortness of breath.”

“An ECG during the office visit showed atrioventricular dissociation.” Lyme disease tests were ordered.

Two days later, Lyme disease tests revealed a positive ELISA and IgM Western blot.

Lyme carditis can cause sudden death. These 2 cases highlight the importance of early recognition. And treatment, even if it’s empirical, may save lives. CLICK TO TWEETShe was prescribed doxycycline. But the next day, before she took the first dose, “her cardiac monitoring recorded atrioventricular dissociation evolving to ventricular tachycardia after an R-on-T electrical impulse,” writes Marx.

In both patients, an evaluation of postmortem heart tissue found lymphohistiocytic pancarditis with immunohistochemical and molecular evidence of the spirochete Borrelia burgdorferi.

Spirochetes were directly visualized in endocardial tissue [taken] from the Massachusetts patient,” writes Marx.

Lyme carditis was high on the list of possible diagnoses, according to Marx. Yet, neither patient was treated empirically with antibiotics when Lyme disease testing was performed.

The patients might have received treatment had the guidelines been followed.²

Guidelines recommend simultaneous initiation of empirical antibiotic therapy and Lyme serologic testing when Lyme carditis is suspected,” states Yeung et al.

“Lyme carditis can progress rapidly,” explains Marx, “waiting for confirmatory diagnostic therapy to initiate antibiotic treatment may result in negative outcomes.”

References:
  1. Marx GE, Leikauskas J, Lindstrom K, Mann E, Reagan-Steiner S, Matkovic E, Read JS, Kelso P, Kwit NA, Hinckley AF, Levine MA, Brown C. Fatal Lyme Carditis in New England: Two Case Reports. Ann Intern Med. 2019 Oct 22.
  2. Yeung C, Baranchuk A. Diagnosis and treatment of Lyme carditis: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;73:717-26

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**Comment**

This is just asinine.  Doctors are so afraid of Lyme/MSIDS they would rather have patients die before prescribing antibiotics.  Things must change.

The body count continues to mount in Lyme land.

Study Identifies 189 Children With Lyme Carditis

https://danielcameronmd.com/study-identifies-189-children-with-lyme-carditis/

STUDY IDENTIFIES 189 CHILDREN WITH LYME CARDITIS

In reviewing medical records from a Pediatric Health Information System (PHIS) database between 2007 and 2013, clinicians identified 189 children diagnosed with Lyme carditis.

“The burden of Lyme disease and Lyme carditis in U.S. children’s hospitals has increased in recent years,” writes Beach and colleagues in Pediatric Cardiology.

In their article “Increasing Burden of Lyme Carditis in United States Children’s Hospitals,” Beach et al.¹ reveal the rise in Lyme carditis cases throughout the U.S. The largest increases, they write, were found in the Midwest, including the Ohio valley.

According to the authors, the children with Lyme carditis were older than children with Lyme disease, who did not have Lyme carditis. On average, they were 13 years old and more likely to be male.

“Encounters for Lyme carditis are dramatically costlier than those for Lyme disease without carditis,” the authors explain. In fact, the median cost of treating a child with Lyme carditis was $9,104 with a range of $3,741 to $19,003. The median cost of treating a child with Lyme disease without Lyme carditis was $922 with a range of $238 to $4,987.

None of the 189 children identified in the database died. However, the database did not include out-of-hospital outcomes.

In the study, there was a broad range of cardiac codes identified among the 189 children. The authors could not be sure of the accuracy of the cardiac codes or whether there were pre-existing cardiac cases.

The list of cardiac cases is much broader than heart block, as identified in the Centers for Disease Control and Prevention’s (CDC) surveillance case definition.

Cardiac codes for 189 children with Lyme carditis

Out of the 189 children, cardiac codes identified in the database included:

First degree AV block – 28%
Acute myocarditis – 27%
Complete AV block – 17%
Second degree AV block – 15%
Heart disease NOS – 9%
Non-specific ECG abnormality – 4%
Cardiomyopathy – 4%
Premature beats – 3%
Right bundle branch block – 3%
Acute pericarditis – 2%
Atrial fibrillation/flutter – 2%
Suspected cardiovascular disease – 2%
Paroxysmal ventricular tachycardia – 2%
Cardiac arrest – 2%
Congestive heart failure NOS – 2%
Conduction disorder NOS – 1%
Left bundle branch block – 1%
Anomalous AV excitation – 1%
Paroxysmal supraventricular tachycardia – 1%
Paroxysmal tachycardia – 1%
Pericardial disease NOS – 1%
Other cardiac dysrhythmias – 38%

Additional costs

The authors were not able to address other costs due to Lyme carditis. “In addition to this financial burden, it is important to consider the additional costs of missed school and work, long-term morbidity, and emotional distress when considering the importance of preventing, diagnosing, and treating Lyme carditis,” writes Beach.

“The increasing number of serious cardiac events and costs associated with Lyme disease emphasize the need for prevention and early detection of disease and control of its spread,” the authors conclude.

Increasing Burden of Lyme Carditis in United States Children’s Hospitals

https://www.ncbi.nlm.nih.gov/pubmed/31728570/

2019 Nov 14. doi: 10.1007/s00246-019-02250-9. [Epub ahead of print]

Increasing Burden of Lyme Carditis in United States Children’s Hospitals.

Abstract

We sought to characterize the shifting epidemiology and resource utilization of Lyme disease and associated carditis in US children’s hospitals. We hypothesized that the Lyme carditis burden has increased and that hospitalizations for Lyme carditis are costlier than those for Lyme disease without carditis. The PHIS database was queried for Lyme disease encounters between January 1, 2007 and December 31, 2013. Additional diagnostic codes consistent with carditis identified Lyme carditis cases. Demographic, clinical, and resource utilization data were analyzed. All costs were adjusted to 2014 US dollars. Lyme disease was identified in 3620 encounters with 189 (5%) associated with carditis. Lyme disease (360 cases in 2007 vs. 672 in 2013, p = 0.01) and Lyme carditis (17 cases in 2007 vs. 40 in 2013, p = 0.03) both significantly increased in frequency. This is primarily accounted for by their increase within the Midwest region. Carditis frequency among cases of Lyme disease was stable (p = 0.15). Encounters for Lyme carditis are dramatically costlier than those for Lyme disease without carditis [median $9104 (3741-19,003) vs. 922 (238-4987), p < 0.001] The increase in Lyme carditis cases in US children’s hospitals is associated with an increased Lyme disease incidence, suggesting that there has not been a change in its virulence or cardiac tropism. The increasing number of serious cardiac events and costs associated with Lyme disease emphasize the need for prevention and early detection of disease and control of its spread.

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For more:  https://madisonarealymesupportgroup.com/2019/02/21/diagnosis-treatment-of-lyme-carditis/

https://madisonarealymesupportgroup.com/2019/11/04/suspect-lyme-carditis-start-empiric-antibiotics-case-report-suggest-and-lyme-carditis-is-not-rare/

https://madisonarealymesupportgroup.com/2018/07/09/with-unexpected-death-autopsies-should-look-for-lyme-carditis/

Excerpt:  “Lyme expert Dr. Daniel Cameron has done a nice job of summarizing five cases in a blog. http://danielcameronmd.com/autopsy-study-reviews-cases-due-to-sudden-cardiac-death-from-lyme-disease/
Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. (March 2016)
http://ajp.amjpathol.org/article/S0002-9440(16)00099-7/abstract
Excerpt:

Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients.”

https://madisonarealymesupportgroup.com/2019/05/15/lyme-carditis-presenting-as-atrial-fibrillation/

https://madisonarealymesupportgroup.com/2018/02/22/new-lyme-cme-course-available-lyme-carditis-more-than-blocked-beats/

https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/

Suspect Lyme Carditis? Start Empiric Antibiotics, Case Report Suggest (And Lyme Carditis is Not Rare!)

https://www.medscape.com/viewarticle/920145

Suspect Lyme Carditis? Start Empiric Antibiotics, Case Report Suggest

By Jennifer Garcia

October 21, 2019

Lyme carditis, caused by infection with the spirochete Borrelia burgdorferi, is a rare but potentially fatal complication that may be prevented with rapid empiric antibiotic treatment.

In a new case report, public health officials describe two patients from areas where Lyme disease is endemic. The patients presented with vague, nonspecific signs and electrocardiogram (ECG) changes suspicious for Lyme carditis.

Although borreliosis was suspected and was tested for, neither patient received antibiotic therapy while awaiting test results, and both subsequently died.

“Guidelines recommend simultaneous initiation of empirical antibiotic therapy and Lyme serologic testing when Lyme carditis is suspected. Lyme carditis can progress rapidly, and waiting for confirmatory diagnostic therapy to initiate antibiotic treatment may result in negative outcomes,” write Grace E. Marx, MD, MPH, from the Centers for Disease Control and Prevention in Fort Collins, Colorado, and colleagues.

The authors note that their objective in reporting the cases was

“to remind clinicians of the importance of early recognition and treatment of Lyme carditis.”

The report was published online today in the Annals of Internal Medicine.

The first patient was a 57-year-old man from Vermont who had a 1-week history of fever, fatigue, chest pain, and shortness of breath. Erythematous macules were noted on the trunk, and ECG revealed first-degree atrioventricular block. Despite consultation with an infectious disease physician and positive results for B burgdorferi, antibiotic therapy was not initiated, and the patient died 12 days after initial presentation.

The second patient was a 49-year-old woman from Massachusetts who presented with nausea, vomiting, and severe headache. A CT scan and an ECG were normal. The patient was discharged with antiemetics and analgesics. Two weeks later, she reported syncopal episodes, fatigue, as well as bladder and bowel incontinence. An ECG demonstrated atrioventricular dissociation. Continuous cardiac event monitoring and Lyme testing were ordered. Two days later, results of Lyme testing came in positive, and antibiotics were dispensed. The patient died the following day, before the first antibiotic dose was taken.

Postmortem histopathologic evaluation of heart tissue in both patients revealed

“lymphohistiocytic pancarditis with immunohistochemical and molecular evidence of B burgdorferi.”

The authors acknowledge that Lyme carditis is rare and that only nine other fatal cases have been reported in the literature. However, given the risk for rapid progression in these patients, current guidelines recommend

“temporary pacing by an external pacemaker for patients with symptomatic or high-risk electrocardiographic features.”

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**Comment**

I pray to God that this information is getting to doctors.

Please know Lyme carditis is NOT RARE!  It’s just rarely reported. Also, the fact there are already nine known fatal cases in the literature should cause every doctor to pause and consider. ER doctors also need to know this as many people start off in the ER with heart symptoms but are sent home when they can’t seem to find anything initially.  Unfortunately it isn’t until the heart issues become much more severe or end in death that they are taken seriously.

How many more have to die before doctors wake up?

I personally know patients with serious heart issues that were pooh poohed by doctors. I hope they are still alive.

In this article, CDC expert Dr. Forrester comments that 4-10% of Lyme patients get carditis.  If we take the CDC’s estimate that 300,000 people contract Lyme each year, that’s 12,000 –  30,000 with Lyme carditis. https://madisonarealymesupportgroup.com/2019/02/21/diagnosis-treatment-of-lyme-carditis/

Does that sound rare to you?

https://madisonarealymesupportgroup.com/2018/07/09/with-unexpected-death-autopsies-should-look-for-lyme-carditis/

Excerpt:  “Lyme expert Dr. Daniel Cameron has done a nice job of summarizing five cases in a blog. http://danielcameronmd.com/autopsy-study-reviews-cases-due-to-sudden-cardiac-death-from-lyme-disease/
Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. (March 2016)
http://ajp.amjpathol.org/article/S0002-9440(16)00099-7/abstract
Excerpt:

Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients.”

Please get the word out.  Enough people have died.

Wrongful Dealth Suit Shows Pitfalls of IDSA Lyme Guidelines

https://www.lymedisease.org/elone-wrongful-death-lawsuit-lyme/

Wrongful death suit shows pitfalls of IDSA Lyme guidelines

Rare Presentation of Endocarditis & Mycotic Brain Aneurysm

2019 Aug 16. pii: S0003-4975(19)31173-7. doi: 10.1016/j.athoracsur.2019.06.073. [Epub ahead of print]

Rare Presentation of Endocarditis and Mycotic Brain Aneurysm.

Author information

1
Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care. Electronic address: zbeckerman@austin.utexas.edu.
2
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care.
3
Department of Pediatrics, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas.
4
Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care; Department of Pediatrics, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas.

Abstract

Bartonella endocarditis can be a very elusive diagnosis. The clinical manifestations can vary and, at times, include multiorgan involvement. This case report describes two patients presenting with multiorgan failure, cerebral mycotic aneurysms and valvular endocarditis secondary to Bartonella infection. The complex diagnosis, decision making, and surgical management are described.

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**Comment**

It’s unfortunate that once again the study authors choose the word “rare” regarding Bartonella and/or any tick-borne infection manifestations, as even the most hardened critics admit these pathogens are prevalent and can have highly variable presentations. It would have been much more appropriate that the authors would state it’s the first time these particular findings have been published rather than give people the impression something occurs rarely.

Lyme patients and the doctors treating this appropriately are acutely aware of potential heart involvement:  https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

Again, please keep in mind that current 2-tiered CDC testing is based on blood tests that misses half of all cases and do not look for the organism but the body’s immune response (antibodies):  https://madisonarealymesupportgroup.com/2018/12/16/laboratory-testing-for-lyme-disease/  Current CDC guidelines were created for surveillance purposes only but are being used diagnostically. All patients should be informed that they can still be infected despite a negative test. 

Also, please be aware of the conflicts of interest regarding patents on testing:  https://madisonarealymesupportgroup.com/2019/06/28/who-owns-the-elisa-patents/

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There are going to be patients with heart symptoms that have an underlying tick-borne illness but test negatively (seronegative). These people are falling through the cracks of the medical symptom yet could be greatly helped with appropriate antimicrobial treatment. If you suspect you are one of these people or suspect others, please give the validated Horowitz questionnaire to them to take to their practitioner:  https://madisonarealymesupportgroup.com/2017/09/05/empirical-validation-of-the-horowitz-questionnaire-for-suspected-lyme-disease/ It also takes an open mind and trained eye to diagnose these patients, and it can be Lyme, Baronella, or any one of many pathogens transmitted by ticks:  https://madisonarealymesupportgroup.com/2019/08/22/early-diagnosis-necessitates-lyme-savvy-doctors/  I hope doctors are waking up to the growing need for education regarding the growing link between tick-borne illness and heart issues.