Purpose of Review
To review myocarditis and pericarditis developing after COVID-19 vaccinations and identify the management strategies.
Recent Findings
COVID-19 mRNA vaccines are safe and effective. Systemic side effects of the vaccines are usually mild and transient. The incidence of acute myocarditis/pericarditis following COVID-19 vaccination is extremely low and ranges 2–20 per 100,000. The absolute number of myocarditis events is 1–10 per million after COVID-19 vaccination as compared to 40 per million after a COVID-19 infection. Higher rates are reported for pericarditis and myocarditis in COVID-19 infection as compared to COVID-19 vaccines.
Summary
COVID-19 vaccine–related inflammatory heart conditions are transient and self-limiting in most cases. Patients present with chest pain, shortness of breath, and fever. Most patients have elevated cardiac enzymes and diffuse ST-segment elevation on electrocardiogram. Presence of myocardial edema on T2 mapping and evidence of late gadolinium enhancement on cardiac magnetic resonance imaging are also helpful additional findings. Patients were treated with non-steroidal anti-inflammatory drugs and colchicine with corticosteroids reserved for refractory cases. At least 3–6 months of exercise abstinence is recommended in athletes diagnosed with vaccine-related myocarditis. COVID-19 vaccination is recommended in all age groups for the overall benefits of preventing hospitalizations and severe COVID-19 infection sequela.
A 16-year-old male with past medical history of congenital atrial septal
defect surgical repair presented with recurrent pericarditis secondary
to post-cardiotomy injury syndrome (PCIS). After failing medical
therapy, he ultimately underwent pericardiectomy for symptom resolution.
PCIS is underdiagnosed in children and should be considered in patients
with recurrent chest pain.
A 46-year-old woman underwent pericardiocentesis and pericardial window
for recurrent pericardial effusion. She presented 17 months later with
signs and symptoms consistent with constrictive pericarditis. Cardiac
magnetic resonance imaging revealed an infiltrative mass surrounding the
pericardium. A transcutaneous core needle biopsy of the pericardium
confirmed the diagnosis of pericardial mesothelioma.
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