by Jenny Lelwica Buttaccio
Posted 3/8/19

Ryan Stewart, a speech-language pathologist (SLP) in Virginia, developed a strange set of symptoms in 2009 that baffled one doctor after another. Included among those symptoms were a racing heartbeat following minimal physical exertion, heart palpitations, shortness of breath, and chest pain. “It felt like an elephant was sitting on my chest,” she explains.

Over the next 10 years, Stewart’s symptoms waxed and waned. Some days, they would let up; other days, a sudden episode of rapid heartbeats or dizziness would frighten her — sending her to the emergency room or an urgent care clinic.

Unfortunately, she always left those healthcare facilities without answers. Though Stewart believed her symptoms stemmed from her heart, repeated electrocardiograms (EKG), a cardiac MRI, and a couple week-long stints of wearing heart monitors all came back as normal. “They could never catch a cardiac episode,” she says.

Determined to live a normal life, Stewart continued her work as an SLP and began planning a family with her husband. After a series of fertility treatments, she became pregnant only to suffer a miscarriage in the early weeks — a devastating loss, she says.

Shortly after the miscarriage, a new group of debilitating symptoms emerged, which included crushing fatigue, heaviness and weakness throughout her whole body, postural orthostatic tachycardia syndrome (POTS), numbness, and tingling. By now, it was 2013, and at the recommendation of a family friend, Stewart rallied the strength to see another doctor — a Lyme-literate one, though she didn’t realize it at the time.

This appointment, however, was different than the previous ones, and she received some surprising, but much-needed news: Stewart had Lyme disease, along with Babesia, Bartonella, and a high Epstein-Barr viral load. “Lyme wasn’t even on my radar!” she recalls. Simply having these diagnoses was a relief, but it wasn’t enough to solve the issues affecting her cardiovascular system.

“I have a heart arrhythmia, which was finally diagnosed in 2016,” she says. “And now I had a feeling in my heart and chest that I had never had before. My heartbeat had no rhythm, and it was fluttering.” Stewart likens the feeling she experienced in her chest to a switchboard in which electrical lights pop up in many different directions, one right after the other.

“I knew this was a new symptom, and I had to go to the ER,” says Stewart. “They discovered I had ventricular tachycardia, and gave me a diagnosis of idiopathic ventricular tachycardia. ‘Idiopathic’ meaning they didn’t know what the cause was.”

Since then, Stewart has tried numerous ways to address her symptoms. Her current treatment involves using beta blockers; she tried antiarrhythmic drugs, but the side effects were intolerable. She’s currently pursuing treatment for Lyme disease, too, and she’s investigating herbal therapies, stress reduction, and other lifestyle modifications in the hopes of improving her overall health.

Stewart’s story highlights some of the signs and symptoms associated with Lyme disease and the cardiovascular manifestations of the illness. To date, there’s no absolute consensus on the prevalence of cardiac involvement in people with Lyme disease. But new research suggests heart symptoms may be present in 0.4% to 10% of Lyme disease cases, according to a 2019 study in the Journal of the American College of Cardiology.

To understand what happens to a heart impacted by Lyme, it helps to first know how a healthy heart functions.

An Overview of the Cardiovascular System

In a healthy person, the heart pumps blood like a well-oiled machine, which delivers critical nutrients and oxygen to every cell, tissue, and organ in the body, and it removes carbon dioxide and other waste products from those tissues. Blood flows in the same direction throughout the body — arteries carry oxygenated blood away from your heart, and veins return oxygen-poor blood back to the heart.

The average heart is larger than the size of an adult fist, and it’s the hardest working muscle in the body, pumping approximately 115,000 times a day. Here are some important points to remember about the heart:

  • It consists of four chambers, including two atria and two ventricles.
  • There are two atria, known as the right and left atrium. The right atrium receives deoxygenated blood from a large vein called the vena cava; the left atrium receives deoxygenated blood from the lungs.
  • The ventricles’ job is to collect and expel blood that comes from the atria. The right ventricle pumps deoxygenated blood into the vascular tree of the lungs where it receives oxygen. Then, the left ventricle pumps the oxygen-rich blood back to the tissues of the body.
  • The upper wall of the right atrium houses a cluster of cells known as the sinoatrial node (SA node). The SA node is referred to as the “heart’s natural pacemaker,” because it produces the electrical activity that’s responsible for the rate and rhythm of your heartbeat.

Your heart and your circulatory system, which contain a vast network of blood vessels that circulate blood through your body and return it to the heart, function as one unit known as the cardiovascular system. The cardiovascular system has such an expansive network of blood vessels that if they were laid out from end to end, they would cover roughly 60,000 miles — that’s enough to go around the globe more than two times.

When Lyme Disease Enters the Picture

Like many other Lyme experts and patients, Dr. Bill Rawls, Medical Director of Vital Plan, believes many more than one in 10 people with Lyme disease may have some degree of heart issues. The symptomatology can vary from person to person, and exist on a spectrum of mild to severe.

The likely bacterial and viral culprits causing cardiovascular symptoms include Borrelia (the primary bacteria implicated in Lyme), Bartonella, Mycoplasma, cytomegalovirus (CMV), and probably many others. These stealth microbes enter the body and spread throughout the tissues by various mechanisms. They have one goal: Survival, notes Dr. Rawls. And they migrate or set up camp anywhere they can in the body, including the heart.

“There’s a growing body of evidence showing that we have microbes throughout our body and brain, including on heart valves,” says Dr. Rawls. “Often, I think these microbes are present without causing harm. They stay dormant in tissues until a disruption in the immune system occurs and depresses it, allowing the microbes to flourish.”

When stealth pathogens thrive, they can alter the electrical signaling to the heart, affecting the heartbeat or causing irritation to the heart itself.

“In a healthy heart, the SA node starts an electrical wave that spreads from cell to cell throughout the heart — the electrical impulses are such that the valves are opening and closing in proper order, or in other words, the heart is beating correctly,” explains Dr. Rawls. “But if another area of the heart gets irritated or inflamed by an infection or stealth pathogen, it may fire first and overwhelm the SA node, disrupting the heart’s regular impulses.” The result: The heart beats irregularly, and the contraction becomes less efficient at pumping blood.

Additionally, an abnormal heart rate isn’t the only way microbes can affect the heart. As the pathogens disseminate throughout the organ and further irritate the heart muscle, the heart can become oxygen-deprived, leading to angina (chest pain), heart attack, shortness of breath, and more.

Signs That Lyme is At Play in the Heart

For most people with Lyme disease and other chronic illnesses like fibromyalgia and chronic fatigue syndrome, we become accustomed to symptoms that fluctuate from one day to the next. We’re so used to it, in fact, that we often adopt a wait-and-see approach to the newest symptom du jour.

But there are times when our bodies give us warning signs — red-flag symptoms that we should get checked out as soon as possible, even if going to the doctor seems uneventful or inconvenient. The primary symptoms to seek medical attention for include irregular heartbeats that aren’t going away, persistent chest pain, or shortness of breath associated with exertion, says Dr. Rawls.

However, cardiac issues may not always be so apparent, because the symptoms can range from mild to more severe, or they can be easily confused with other causes. Other signs to be aware of include:

  • Dizziness
  • Lightheadedness
  • Fainting
  • Shortness of breath
  • Pressure or tightness in the chest
  • Pain radiating to the neck or down the arm
  • Heart palpitations
  • Cold sweats
  • Fatigue
  • Nausea or vomiting

Let’s look at three conditions that can be caused when Lyme, coinfections, or other stealth pathogens affect the heart, including the most well-known one called Lyme carditis.

1. Lyme Carditis

Most people with Lyme are aware that Lyme carditis (LC), which causes inflammation in the heart, is the most serious cardiac manifestation of Lyme disease. Symptoms may develop and progress rapidly, even as quickly as one week after the bite of an infected tick.

No parts of the heart are off limits to these insidious microbes. They can affect the heart’s muscle tissues (myocardium), the membrane that encases the heart (pericardium), the tissues that line its chambers (endocardium), the valves, the aorta, and sometimes a combination of the different parts of the heart.

An inflamed heart impacts the way the SA node operates the heart’s electrical system. It tends to slow the heart down due to a condition known as a heart block, or atrioventricular block (AV block), which varies in severity from first-degree to third-degree.

  • In first-degree heart block, the electrical impulses reach the ventricles — the bottom chambers of the heart — at a slower than normal pace.
  • The condition can progress to a second-degree heart block, where the heart produces electrical signals, but they only partially reach the ventricles. In some cases, they don’t reach it at all.
  • In a third-degree or complete heart block, the electrical signals are completely obstructed from reaching the ventricles. One sign of complete heart block is a pulse of less than 60 that doesn’t increase with exertion, and intolerance to exertion.

When the heart is unable to pump blood efficiently, it can’t provide the body with adequate, oxygenated blood. If caught early, a heart block can often be resolved with antibiotics and occasionally, the use of a temporary pacemaker to maintain the electrical activity of the heart. If not swiftly and adequately treated, the result could be the placement of a permanent pacemaker or sudden cardiac death (SCD).

Generally, most cases of Lyme carditis occur during June through December, according to an article in the journal Circulation, and it seems to occur slightly more in males than in females. Additionally, LC is more likely to be found in individuals who fall into the age groups of 5 to 14 and 44 to 59 years of age.

At the present time, researchers are unsure of whether an underlying cardiac condition poses an increased risk of developing LC compared to those in the general population who contract Lyme disease.

2. Myocardial Infarction

A myocardial infarction (MI) is commonly known as a heart attack. It happens when a part of the heart is unable to receive oxygen due to a blockage in the coronary artery, which causes damage to the heart muscle. The journal, Infectious Disease Clinics of North America, lists it as another possible cardiac manifestation of Lyme disease. However, it’s difficult to know how common heart attacks are among Lyme patients, especially since many cases of the illness are misdiagnosed in both the acute and chronic stages of the disease.

3. Heart Arrhythmias

An abnormal heartbeat where the heart is beating too slowly, too rapidly, or irregularly is categorized as an arrhythmia. There are several types of arrhythmias. For instance, when the heart beats too slowly, it’s called bradycardia; when it beats too quickly, it’s referred to as tachycardia.

Some arrhythmias may be benign or harmless. But others, such as the type experienced by Stewart, can bring about a distressing set of symptoms. Because arrhythmias can have the potential to be life-threatening, you should be persistent about visiting your doctor and getting a proper diagnosis.

When diagnosing Lyme-related cardiac conditions, there are a battery tests your doctor might want you to undergo, such as those that Stewart was required to do. Common testing methods may include blood work, an EKG, an echocardiogram, a cardiac MRI, wearing various heart monitors, and more. And, like Stewart’s case, testing doesn’t always capture problems on the first go-around, so it might take multiple efforts to get the right diagnosis.

Could other conditions impact cardiac function as a result of Lyme disease, too? Probably: medical literature names coronary artery aneurysms, QT-interval prolongation, and congestive heart failure (CHF) among other reported heart manifestations.

However, very few statistics, if any, exist regarding the prevalence of these conditions among Lyme patients. The medical community still has a lot to learn about the way Lyme disease, co-infections, and other microbes impact the heart.

How to Improve Heart Health

“Anytime you have something irregular with the heart, you should have someone check it out,” advises Dr. Rawls. “The threshold for being evaluated for heart symptoms should be pretty low.” In other words, if your heart feels off — you’re experiencing chest pain, shortness of breath, an irregular heartbeat, or something else — get to a doctor as soon as possible.

While testing can help pinpoint what’s going on, it may not always be spot on the first time you’re evaluated, and you might need to be persistent in pursuing a diagnosis. From one patient to another, Stewart says, “When it comes to something serious like your heart, don’t stop searching for answers. Trust your instincts, and don’t ignore it.”

Once you know what you’re dealing with, you and your doctor can establish a plan of care, which may include antibiotics, particularly in the acute stages of Lyme disease. Other drug therapies include beta blockers and antiarrhythmic drugs, which might be necessary to stabilize your heart rate and prevent abnormal rhythms. However, those drugs can come with a long list of side effects, and the length of time you could be required to take them will differ from physician to physician and the severity of your illness.

Some people may need to have a temporary pacemaker implanted into the heart to regulate heart rhythms. Additionally, another treatment you may hear mentioned is a catheter ablation for arrhythmias. This procedure destroys the abnormal cells in the heart that are misfiring. Fortunately, neither of these procedures are needed very often.

It’s important to note that lifestyle modifications and herbal interventions can also play a critical role in managing cardiac symptoms and helping the heart heal. Because herbs have a normalizing effect on the body and a low chance of toxicity, they can be used in conjunction with many medication regimens.

“Herbs may allow a person the ability to take less medication and reduce the side effects of drugs. I think it’s important for people to note that herbs are restorative to the body and support healing,” says Dr. Rawls. But of course, making the decision to take any natural regimen should be in partnership with your healthcare provider. Here are some of the herbs Dr. Rawls recommends:

1. To improve the heart’s electrical rhythms and the strength of its contractions, and to enhance blood flow:

2. To increase oxygenation of the tissues in the body and bolster the immune system:

3. To help decrease your microbial load:

4. For additional support:

  • Magnesium, a mineral that helps the heart maintain a steady heartbeat
  • CoQ10, a powerful antioxidant
  • Krill oil or fish oil, potent anti-inflammatories

Words of Encouragement

Why do some people have heart issues with Lyme disease and others don’t? Dr. Rawls postulates that some of us may have a genetic predisposition or a certain spectrum of microbes that, when combined with lifestyle factors like high stress levels, poor diet, a toxic environment, and inactivity, makes us more vulnerable to cardiovascular involvement.

Also, “It depends on immune system functions,” Dr. Rawls says. “Some combinations of these factors may be more concerning than others, and that’s a part of the puzzle that we don’t know yet.”

For those who do face the daily stress of dealing with Lyme disease and cardiac symptoms, it can be overwhelming and scary at times — it’s easy to feel like the illness has stolen precious parts of your life, and coping can be a struggle. For them, Stewart offers these hard-earned words of encouragement:

“Try as hard as you can not to lose yourself in your diagnosis,” she says amid her own personal struggles. “Surround yourself with the things that you love and try to do one thing daily. You can still do things, but you may have to adapt them. There’s always another way to pursue your dreams — I believe you can still achieve them.”

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

REFERENCES
1. Arrhythmia. Medline Plus website. https://medlineplus.gov/arrhythmia.html
2. Basic Anatomy of the Heart. Johns Hopkins Medicine website. https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/basic_anatomy_of_the_heart_85,P00192
3. Pinto DS. Cardiac manifestations of Lyme disease. The Medical Clinics of North America. 2002 Mar;86(2):285-96. doi: 10.1016/S0025-7125(03)00087-7
4. Heart Chambers. Medline Plus website. https://medlineplus.gov/ency/imagepages/19612.htm
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