О. Zinchuk
Danylo Halytsky Lviv National Medical University
Introduction. Lyme borreliosis (LB) is a polysystemic infectious disease caused by a bacterium Borrelia burgdorferi and transmitted through the suction of ixodic ticks. In the last decade, the incidence of LB in Ukraine has risen steadily; it is officially classified as a group of particularly dangerous infectious diseases. LB often runs syntopetically in the pathologic process of various organs and systems. Heart failure is often found in case of LB, but it is poorly investigated.
Aim. To find out the clinical-electrocardiogram signs of heart disease in patients with LB in the western region of Ukraine.
Materials and methods. There were 352 patients with LB who were inpatient and outpatient care in the Lviv Regional Infectious Diseases Hospital in 2000-2008. Among the patients, there were 129 men and 223 women. The average age was 45.61 ± 0.81 years. Diagnosis of LB was based on the results of epidemiological, clinical and laboratory and instrumental studies. A clinical case of severe heart failure in a patient with a chronic course of Lyme borreliosis was described.
Results. Symptoms of heart function abnormalities were detected in 72 patients (21.6%) out of 333 who were diagnosed with early-onset LB. In 55 of them (16.5%) there were clinical signs of heart disease. Changes in EG were detected in 46 (18.2%) out of 253 surveyed.
The most frequent clinical signs that indicated a disorder of the function of the heart were a feeling of discomfort or pain in the area of the heart. Sternal discomfort was seen in18 patients of 333 (5.4%), in 16 (4.8%) – pain in the heart region. 22 patients (6.6%) showed the weakening of the heart tones, 13 (3.9%) – systolic murmur on the apex.
An echo study showed that some patients combine several echogenic signs – most often bradycardia with ventricular extrasystoles or conduction disorders of varying degrees. These changes were usually short-lived and disappeared after the treatment with antibiotics.
Antimicrobial treatment in common doses (Uniodox – 4 patients, Ceftriaxone – 3 patients, Amoxicillin – 1 patient) contributed to the gradual normalization of the condition of the patients. Clinical and ECG-changes in patients with myocarditis normalized within 3-4 weeks – in 6 out of 8. In 2 patients after discharge from the clinic, the relaxation of cardiac tones, ventricular repolarization disorders in the form of tinnitus reduction, which required the additional treatment, was maintained.
Despite the benign course of myocarditis in most patients with LB, the lack of early specific antimicrobial treatment due to the inadequate diagnosis can be a reason for the progression of the pathologic process in heart tissue with severe consequences.
Conclusions. It was found that the clinical symptoms of heart disorders were present in 16.5 % of patients in early period of Lyme borreliosis and electrocardiographic changes – in 18.2 %. These symptoms were present more often in the group of the patients without erythema migrans. There were 2.4 % of patients in early period of the disease with the symptoms of myocarditis. These patients need a permanent detailed monitoring of the cardiac activity during all periods of the disease for the prescription of an adequate treatment.
Reference
- Order of the Ministry of Health of Ukraine N 133 dated 19.07.95. On Approval of “List of Especially Dangerous, Dangerous Infectious and Parasitic Diseases of a Human and Carrier of the Pathogens of These Diseases”.
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