Lyme carditis may present with sudden death. The diagnosis should be considered in any patient with unexplained sudden death especially if certain risk factors are present.
Features of sudden death associated with untreated Lyme carditis:
(1) The patient lives in or has been to a region endemic for Lyme disease.
(2) The patient may complain of new onset of chest pain, palpitations, lightheadedness, dyspnea, and/or syncope.
(3) An ECG if available may show first, second or third degree heart block.
(4) The patient has a sudden cardiac arrest with death.
If a case is suspected then the diagnosis can be confirmed by:
(1) serology
(2) immunohistochemistry
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