A case of a 26-year-old man with Lyme carditis (LC) mimicking acute coronary syndrome is presented. Considering clinical presentation, electrocardiographic findings and markedly elevated levels of cardiac biomarkers, emergency coronary angiography was performed and revealed normal coronaries. Ventricular arrhythmias of Lown grade IVb during catheterization were recorded. Echocardiography showed mild global left ventricular dysfunction with ejection fraction of 50%. The diagnosis of LC was confirmed by ELISA and Western blot serologic testing. After 21 days of continuous antibiotic therapy with ceftriaxone (2.0 g/d) the patient recovered completely. We also present the current state of knowledge on the cardiovascular aspects of Lyme borreliosis.