The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Lack of Cardiac Manifestations among Patients with Previously Treated Lyme Disease

Oliver Sangha, MD, MPH; Charlotte B. Phillips, RN, MPH; Kirsten E. Fleischmann, MD, MPH; Thomas J. Wang, MD; Anne H. Fossel; Robert Lew, PhD; Matthew H. Liang, MD, MPH; and Nancy A. Shadick, MD, MPH
[+] Article, Author, and Disclosure Information

From Brigham and Women's Hospital, Boston, Massachusetts. Acknowledgments: The authors thank Mark Link, MD, for valuable advice and interpretation of electrocardiograms, Karin Fossel for expert data management, and Mary Scamman for help with manuscript preparation. Grant Support: In part by National Institutes of Health grants AR36308 and AR02033. Dr. Sangha is supported in part by a fellowship grant from the German Academic Exchange Service (DAAD). Dr. Shadick is a recipient of an Arthritis Foundation Arthritis Investigator Award. Requests for Reprints: Nancy A. Shadick, MD, MPH, PB2 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Current Author Addresses: Drs. Shadick and Liang: PB2 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(5):346-353. doi:10.7326/0003-4819-128-5-199803010-00002
Text Size: A A A

Background: Cardiac involvement is common in acute Lyme disease, and case reports suggest that cardiac abnormalities might also occur years after the primary infection.

Objective: To determine the prevalence of cardiac abnormalities in persons with previously treated Lyme disease.

Design: Population-based, retrospective cohort study with controls.

Setting: Nantucket Island, Massachusetts.

Participants: From among 3703 adult respondents to a total-population (n = 6046) mail survey, 336 (176 case-patients and 160 controls) were randomly selected for clinical evaluation.

Measurements: Current cardiac symptoms and major or minor abnormal electrocardiographic features, including heart rate; rhythm; axis; PR, QRS, and QT intervals; QRS structure; atrioventricular blocks; and ST-segment and T-wave changes.

Results: Persons with Lyme disease (case-patients, n = 176) (mean duration from disease onset to study evaluation, 5.2 years) and persons without evidence of previous Lyme disease (controls, n = 160) did not differ significantly in their patterns of current cardiac symptoms and electrocardiographic findings, including heart rate (P > 0.2), PR interval (P = 0.15), QRS interval (P > 0.2), QT interval (P > 0.2), axis (P > 0.2), presence of arrhythmias (P > 0.2), first-degree heart block (P = 0.12), bundle-branch block (P > 0.2), and ST-segment abnormalities (P > 0.2). In multivariate analyses that adjusted for age, sex, and previous heart disease, a history of previously treated Lyme disease was not associated with either major (odds ratio, 0.78; P > 0.2) or minor (odds ratio, 1.09; P > 0.2) electrocardiographic abnormalities.

Conclusion: Persons with a history of previously treated Lyme disease do not have a higher prevalence of cardiac abnormalities than persons without a history of Lyme disease.


lyme disease ; heart


Grahic Jump Location
Figure 1.
Sampling strategy and study design used to determine case status and measure clinical and electrocardiographic outcomes in persons with and without previous Lyme disease.

*Adults 17 years of age and older. †Thirteen persons were excluded because of difficulties with electrocardiography or because the persons declined to be evaluated. CDC − Centers for Disease Control and Prevention.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.