Lyme Carditis: A Rare Case of Heart Failure in the Absence of Ischemic Heart Disease

BACKGROUND Lyme carditis typically presents with atrio-ventricular block; however, other cardiac manifestations, including varying EKG changes, myopericarditis and new-onset heart failure, can occur. CASE REPORT We report a case of a 52-year-old woman with past medical history significant for hypertension, chronic obstructive pulmonary disease, and chronic back pain who presented with new-onset heart failure in the setting of Lyme carditis. She presented with exertional dyspnea requiring supplemental oxygen, subjective fever, chills, fatigue, and arthralgia of 2-week duration. Her vital signs were consistent with hypotension and persistent bradycardia. An EKG displayed T-wave flattening in the anterior pre-cordial leads. Further work-up was suggestive of bilateral pulmonary edema and interstitial infiltrates, which required antibiotics and diuretics. Echocardiography demonstrated new-onset mildly depressed LV systolic dysfunction. Interestingly, coronary CTA revealed coronary arteries with no evidence of stenosis or plaque. She was found to have positive Lyme IgM and lgG antibodies. A diagnosis of Lyme myocarditis was considered and her antibiotic course was extended following multidisciplinary consensus. CONCLUSIONS This case report seeks to create awareness of the varying and atypical presentations of Lyme carditis, including new-onset heart failure in a patient without prior history of ischemic heart disease and uncommon EKG changes.