An article published in the Canadian Medical Association Journal (CMAJ) advises physicians and emergency room personnel to consider Lyme disease as a possible diagnosis when a patient presents with heart palpitations and shortness of breath.


In July 2018, a 37-year-old man named Samuel went to a doctor with symptoms of fever, sore throat, nasal congestion and a rash. He said he also had circular marks on his back and chest in late June, but he thought he got them while picking raspberries. A few weeks later, he went to a walk-in clinic because he had shortness of breath and heart palpitations. He was referred to an emergency department where he was found to have a heart rate of only 42 beats per minute and a ECG showed complete heart block. Despite efforts to stabilize him, Samuel died just two days later.

Though Samuel and his family lived in a remote and wooded area of Manitoba and he had spent time outdoors, he didn’t believe he had been bitten by a tick. However, serological tests showed he did indeed have Lyme disease.

In their CMAJ paper, Drs. Milena Semproni, Richard Rusk and Terence Wuerz, all with the department of medical microbiology and infectious diseases in the UM Rady Faculty of Health Sciences and at the St. Boniface General Hospital, note that Lyme disease as a diagnosis may be overlooked by clinicians, especially as the disease moves into new geographic areas.

They explain: “Patients presenting with AV block should be questioned about a preceding history of rash or constitutional symptoms, exposure to ticks and time spent in Lyme-endemic areas. Clinicians should be aware of the distribution of Lyme disease and its vector in their practice area. Conversely, patients with suspected or confirmed Lyme disease should be questioned regarding cardiac symptoms, such as dyspnea, syncope, chest pain and decreased exercise tolerance. Those who are asymptomatic from a cardiac perspective on presentation should be educated regarding the possibility of cardiac involvement and advised to seek care immediately should they develop any cardiac symptoms.”

Read more at University of Manitoba