Acute myocardial infarction after inactivated COVID-19 vaccination: a case report and literature review

Abstract

A number of vaccines have been developed and deployed globally to restrain the spreading of the coronavirus disease 2019 (COVID-19). The adverse effect following vaccination is an important consideration. Acute myocardial infarction (AMI) is a kind of rare adverse event after COVID-19 vaccination. Herein, we present a case of an 83-year-old male who suffered cold sweat ten minutes after the first inactivated COVID-19 vaccination and AMI one day later. The emergency coronary angiography showed coronary thrombosis and underlying stenosis in his coronary artery. Type II Kounis syndrome might be a potential mechanism, which is manifested as coronary thrombosis secondary to allergic reactions in patients with underlying asymptomatic coronary heart disease. We also summarize the reported AMI cases post COVID-19 vaccination, as well as overview and discuss the proposed mechanisms of AMI after COVID-19 vaccination, thus providing insights for clinicians to be aware of the possibility of AMI following COVID-19 vaccination and potential underlying mechanisms.

Kounis syndrome following COVID-19 vaccination: Clinical manifestations, mechanisms and management

“… Chatterjee S et al 44 ST elevation in leads II, III and aVF, suggestive of acute ST elevated inferior wall myocardial infarction (STEIWMI). Unknown Serum creatine kinase-MB (CK-MB) and cardiac troponin-I (cTnI) were > 150 IU/L (n, <9) and 49.28 ng/ml ( n < 0.04) respectively Inferior wall hypokinesia with left ventricular ejection fraction of 50% Boivin Z et al 45 ST segment elevation in the inferior leads with reciprocal ST segment depression in the lateral leads Patient refused to be examined Initial troponin was 0.07 ng/mL, with a peak of 2.63 ng/mL An ejection fraction of 35%, and an anterior and apical wall motion abnormality consistent with an anterior myocardial infarction (MI) Tajstra M et al 46 Acute ST-segment elevation myocardial infarction of the inferior wall Occlusions or distal embolization in the distal part of the left anterior descending coronary artery, in the first diagonal branch, and in the distal part of the dominant right coronary artery, with large thrombus None None Ou W et al 47 ST segments elevation in leads II, III and avF, with reciprocal depression in leads I and avL 95% stenosis in the right coronary artery (RCA) with thrombotic shadow locally, 80% stenosis in the left anterior descending coronary artery, 70%–80% stenosis in the distal left circumflex coronary artery (d-LCX), and 80%–90% stenosis in the obtuse marginal branch (OM) High sensitivity troponin-T level more than 2,000 (reference: 0–100) ng/L, myohemoglobin 291 (reference: 28–72) ng/ml, creatine kinase (CK) 2771.7 (reference: 50–310) U/L, CK-MB fraction 348.2 (reference: 0–19) U/L, D-dimer 1.09 (reference: 0–0.55) mg/L, and N-terminal pro-brain natriuretic peptide 1,770 (reference: 0–125) pg/ml Hypokinesia on the inferior and posterior walls, with a left ventricular ejection fraction of 54% Srinivasan KN et al 48 Sinus rhythm (SR), and evolved infero-posterior wall myocardial infarction (IPWMI) (TVD) (severe disease of left anterior descending artery (LAD), distal left circumflex(dLCX) and 100% occlusion of distal right coronary artery (dRCA)) Troponin-T tested positive Mild left ventricular hypertrophy (LVH), regional wall motion abnormality (RWMA) involving infero-posterolateral wall with left ventricular ejection fraction(LVEF)of 55% ...…”

Type I Kounis Syndrome: Allergic Myocardial Infarction Triggered by Ciprofloxacin

“…Arachidonic acid and thromboxane products induced platelet aggregation. The combined effect of these mediators is a pro-thrombotic environment leading to coronary spasm or thrombosis (Figure 5 ) [ 10 , 11 ]. Managing KS is challenging due to conflicting approaches to cardiovascular and allergic reaction treatments, as shown in Figure 6 [ 12 ].…”

“…FIGURE 5: Pathophysiology of Kounis syndrome. IgE: immunoglobulin E; FceRI: Fc region of immunoglobulin E; MRGPRX2: mas-related G-protein coupled receptor member X2; C: complementReference:[10,11] …”