Vaccine-associated myocarditis is becoming increasingly documented as a complication of the messenger ribonucleic acid (mRNA) vaccination platform. This complication so far has been found to predominantly affect the younger male population within seven days of receiving the second dose of an mRNA vaccine. We present a case of a 45-year-old male found to have clinical, biochemical, and radiological evidence of myocarditis three days after receipt of the second dose of the Moderna COVID-19 vaccine. Troponin I and inflammatory marker trends, in addition to the use of cardiac MRI imaging, was important in making the diagnosis. Symptom resolution was achieved after two months of colchicine and anti-heart failure medications. We highlight the occurrence of this rare vaccine complication in an endeavor to stress the need for further research to better understand this condition so that better guidance can be provided to the medical community on how best to screen and manage it.
Introduction: Troponin I test has been used as a biomarker for the diagnosis of ACS since 1965. Troponin I has a prognostic value in hospitalized patients with non-cardiac diagnosis. In 2019, The WHO declared COVID-19 as a deadly infectious disease. Given the global impact of this disease, there is a need to identify biomarkers associated with mortality in hospitalized patients. Biomarkers associated with mortality are an important tool for escalation of care in patients deemed at risk of clinical decompensation. The following study demonstrated an association between troponin I elevation and increased mortality among COVID-19 patients. Hypothesis: We sought to determine if Troponin I elevation within 24 hours of admission is associated with increased mortality in COVID-19 patients. Methods: In a retrospective, multicenter study at Atlantic Health System in New Jersey, we analyzed 10,980 first-drawn troponin I values within 24 hours of admission in 34,625 patients between 12/2020-02/2021. Data was analyzed using logistic regression and cox proportional hazard ratio to determine our primary outcome, which is the association of troponin elevation and mortality among COVID-19 patients. Results: The characteristic of 10,980 patients that survived COVID-19 and patients that expired due to COVID-19 during the hospitalization were analyzed. Total of 6,083 were male and 4897 were females. In the survival group, the mean age was 60 with STD 17.2, while in the deceased group the mean age was 74 with STD 13. Logistic regression revealed thatpatients with elevated troponin have increased odds of death compared to others with non-elevated troponin levels (Point estimate 3.301665 ). Females with elevated troponin have greater odds of death than males with elevated troponin ( point estimate 4.484406 in females vs point estimate men 3.301665 ). Patients with elevated troponin have increased hazard by a factor of 1.78 or increased chance of death by 78%. As supporting evidence of our hypothesis patients with an elevated troponin in the first 24 hours have 3.74 increase odds of death. Conclusions: In conclusion, Troponin I elevation within 24 hours of admission is associated with increased mortality in hospitalized COVID-19 patients with 3.7 increase odds of death.
Introduction: Ultrasound-guided measurement of carotid intima-media thickness (CIMT) can be used as a marker to predict future risk of atherosclerotic cardiovascular disease. Achilles tendons are the most common sites of xanthoma accumulation and can serve as a diagnostic index for patients with familial hypercholesterolemia (FH). We report a case of a patient with FH on PCSK9 inhibitor, who was followed up over the course of five-years to monitor the impact of the medication on CIMT and Achilles tendon thickness (ATT). Hypothesis: PCSK9 inhibitors are associated with reduction of carotid artery plaque and regression of tendon xanthomas. Methods: In a prospective study, at Overlook Medical Center in New Jersey, we followed up a 27-year-old patient with FH on PCSK9 inhibitor and high-dose statin diagnosed in 2006. After CABG, patient underwent CIMT and ATT in 2017, 2019 and at the five-year follow up in 2022. Results: In 2017, patient underwent ultrasound of the bilateral common carotids showed CIMT to be 0.91mm on right and 0.78mm on left and ultrasound of bilateral Achilles tendon showed ATT to be 0.91cm on right and 1.11cm on left. In 2019, ultrasound of bilateral common carotids showed CIMT to be 0.5mm on right and 0.57mm on left (mean CIMT reduction of 38%). Ultrasound of bilateral Achilles tendon showed ATT to be 1.04cm on the right and 0.98cm on the left (no significant change). In 2022, patient presented for the 5-year follow up, ultrasound of bilateral common carotids showed CIMT to be 0.55mm on right and 0.54 mm on left (no significant change) Ultrasound of bilateral Achilles tendon showed ATT to be 1.12cm on the right and 1.02cm on the left (no significant change). Conclusions: This case highlights the significant reduction in carotid artery plaque burden within the first two years of treatment with PCSK9 inhibitors. However, CIMT did not have a significant change after the five-year follow up. In addition, the patient didn’t have any significant changes in the Achilles tendon thickness throughout the five-years of treatment. This case illustrates how ultrasound-guided measurement of CIMT may help stratify ASCVD progression and quantify the effect of PCSK9 inhibitor on atherosclerotic plaque.
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