COVID-19 vaccination and cardiac dysfunction

Abstract

The coronavirus disease 2019 (COVID-19) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 infections has reduced the number of symptomatic patients globally. A case series of vaccine-related myocarditis or pericarditis has been published with extensive vaccination, most notably in teenagers and young adults. Men seem to be impacted more often, and symptoms commonly occur within 1 wk after immunization. The clinical course is mild in the majority of cases. Based on the evidence, a clinical framework to guide physicians to examine, analyze, identify, and report suspected and confirmed cardiac dysfunction cases is needed. A standardized workup for every patient with strongly suspicious symptoms associated with the COVID-19 mRNA vaccine comprises serum cardiac troponin measurement and a 12-lead electrocardiogram (ECG). For patients with unexplained elevation of cardiac troponin and pathologic ECG, echocardiography is recommended. Consultation with a cardiovascular expert and hospitalization should be considered in this group of patients. Treatment is primarily symptomatic and supportive. Deferring a 2 nd dose of the COVID-19 mRNA vaccination in individuals with suspected myocarditis or pericarditis after the 1 st dose is suggested until further safety data become available.

Emergency department presentations for chest complaints after mRNA COVID‐19 vaccinations in children and adolescents

“…1,12,13 It is of note that the emergency presentations for vaccine-related chest complaints were equally split between males and females, but abnormal tests and myocarditis had a male predominance, consistent with previous reports. 14,15 Chest pain or discomfort (89%) was the most common presenting symptom, followed by shortness of breath (26.5%) and palpitations (23%), with symptoms broadly similar between those with and without myocarditis. Ng et al 16 described similar symptoms in patients presenting with chest pain postvaccination with or without myocarditis.…”

The clinical progress and challenges of mRNA vaccines

“…Other systemic side effects, such as fever, headache, myalgia, arthralgia, and fatigue, were also more common among vaccine recipients than control, and younger recipients experienced systemic events more frequently, which may represent an enhanced immune response occurs in young people (Polack et al, 2020). Recently studies have shown that hypersensitivity myocarditis appearance in recipients may be related to the administration of the COVID‐19 mRNA vaccine (Leowattana & Leowattana, 2022; Siripanthong et al, 2020). It is still unknown which parts of the mRNA vaccines are responsible for these adverse events.…”