Acute Myocarditis Following Vaccination With the First Dose of the mRNA-1273 Vaccine

Abstract

Viral infections are a common cause of acute myocarditis. However, vaccines including influenza and smallpox have also been rarely implicated. Recently, the coronavirus disease 2019 (COVID-19) vaccines have been associated with acute myocarditis. We describe a case of acute myocarditis in a 19-year-old male 2 days after the initial dose of the COVID-19 mRNA-1273 vaccine. He presented with chest pain radiating to his left arm and bilateral shoulders. COVID, influenza, coxsackie, respiratory syncytial virus polymerase chain reaction (PCR) tests were negative. Electrocardiogram revealed diffuse ST-segment elevation. Initial Troponin was 15.7 ng/mL. A coronary angiogram revealed patent coronary arteries and no wall motion abnormality. A transthoracic echocardiogram showed diffuse hypokinesis with an ejection fraction of 49%. Cardiac magnetic resonance scan was aborted after 2 attempts due to severe claustrophobia. His chest pain resolved following initiation of aspirin, tylenol, colchicine, lisinopril, and metoprolol.

COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare: A Medical and Organizational View

“…Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men [ 59 ]. Similar results have also been reported in recent (2022) original studies [ 60 , 61 ] and systematic literature reviews [ 62 , 63 ], moreover demonstrating that myocarditis and pericarditis after the COVID-19 vaccine have been reported more in young adult males and are most likely to occur after the second dose of mRNA vaccines [ 63 ]. The researchers emphasized that the benefits of SARS-CoV-2 vaccination should be considered when interpreting these findings.…”

Acute myopericarditis and left shoulder capsulitis following second dose of mRNA SARS-CoV-2 Moderna vaccination

“…To our knowledge, this is the first clinical case reporting myopericarditis and shoulder capsulitis in the same patient following anti-SARS-CoV-2 vaccination with the Moderna ®vaccine. The association between myopericarditis and anti-SARS-CoV-2 vaccination has already been demonstrated by numerous studies 17–22. The pathophysiology behind this association is not yet fully understood, but the hypotheses suggest a hyperimmune or inflammatory response, autoimmunity, delayed hypersensitivity or hypersensitivity to vaccine components 23.…”

“…The patient’s shoulder symptoms appeared at the same time as the myopericarditis, that is, about 48 hours after vaccination. Cardiac pathologies cause frequent shoulder pain, whether it is myocardial infarction29 or myopericarditis 19 30. Arm or shoulder pain in cardiac injury is explained by cardiac and shoulder/arm sensory information convergence in the same neurons of the spinothalamic tract, which does not allow accurate localisation projection in the somatosensory cortex 29 31 32.…”

“…Myocarditis and pericarditis have also been reported in association with SARS-CoV-2 vaccination 17–21. A 2022 systematic review showed an incidence rate of 0.001% for myocarditis and 0.0004% for pericarditis 22.…”