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COVID-19 vaccinations have been deployed to mitigate the effects of the COVID-19 pandemic. However, vaccine-associated myocarditis has been reported. Two typical cases in terms of young age and after the second vaccination were admitted to our hospital with symptoms of worsening chest pain, ST elevation on the electrocardiogram (ECG) and creatine kinase elevation. Emergency coronary angiography revealed no coronary arteries, and an endomyocardial biopsy showed no remarkable findings. Their symptoms were resolved within a few days of sufficient rest and non-steroidal anti-inflammatory drug. The ECG of Patient 1 showed typical change; therefore, the diagnosis of myocarditis was easy. However, the ECG of Patient 2 did not show typical change for myocarditis, and there was no abnormality in the wall motion on echocardiography. Cardiac magnetic resonance imaging (MRI), strain analysis by speckle-tracking echocardiography and serial ECG were useful for the diagnosis of myocarditis. This work shows that conducting early examinations with multimodality imaging and sufficient rest are needed to prevent the worsening of vaccine-associated myocarditis. Although the benefits of the vaccines outweigh the risks, we should be aware that myocarditis can occur after COVID-19 mRNA vaccination regardless of race, especially in young males.

SummaryBackground and hypothesis: Genetic influence on development of athlete's heart is uncertain. This study investigated whether angiotensin-converting enzyme (ACE) gene polymorphism influenced development of athlete's heart.Methods: Forty-three participants in a 100-km ultramarathon were classified on the basis of ACE gene polymorphism into a deletion group (n = 26) and an insertion group (n = 17). Echocardiograms were recorded to determine left ventricular end-diastolic and end-systolic diameters, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass, and ejection fraction.Results: Left ventricular end-diastolic diameter (65.5 k 4.0 mm) and left ventricular mass (369.5 k 73.9 g) were significantly larger in the subjects with deletion than in those with insertion (57.4 f 4.2 mm, 306.5 k 93.7 g). However, no significant differences in the other parameters were noted.Conclusions: In long-distance runners, ACE gene polymorphism of the D/D and DA genotypes has a stronger influence

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the α-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.

A 29-year-old woman who worked as a KAATSU (a type of body exercise that involves blood flow restriction) instructor visited our emergency room with a chief complaint of swelling and left upper limb pain. Chest computed tomography (CT) showed non-uniform contrast images corresponding to the site from the left axillary vein to the left subclavian vein; vascular ultrasonography of the upper limb revealed a thrombotic obstruction at the same site, leading to a diagnosis of Paget-Schroetter syndrome (PSS). We herein report our experience with a case of PSS derived from thoracic outlet syndrome (TOS), in a patient who was a KAATSU instructor.

COVID-19 vaccines have been used to counteract the global COVID-19 pandemic. While these are effective, adverse reactions have been reported, such as injection-site pain, muscle ache, fever, palpitation, and chest discomfort. The release of inflammatory cytokines, such as interleukin (IL)-6 and IL-1β, is a potential mechanism for post-vaccine side-effects. Chest discomfort after the vaccination, including myocarditis and acute coronary syndrome, is a particularly serious adverse reaction. It is important to be familiar with the differential diagnoses of chest discomfort and organ-specific diseases associated with COVID-19 vaccines as the preparation for booster shots and vaccinations among children aged 5–11 years begins. High-intensity exercise, alcohol, tobacco smoking, and baths promote inflammatory cytokines, such as IL-6, which may exacerbate the adverse reactions after vaccination. Japanese data show that deaths during baths are the most common for several days after mRNA vaccination. Additionally, alcohol and tobacco smoking were identified as predictive factors of lower antibody titers after vaccination. In this review, we aimed to provide a few recommendations to prevent vaccine-associated disease.

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