COVID-19 Vaccine–Related Myocardial and Pericardial Inflammation

Abstract

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.

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

“…Severe side effects of COVID-19 vaccination have particularly an overlap with symptoms of COVID-19. For example, myocarditis and pericarditis have been found in association with COVID-19 [148] , [149] , [150] , [151] , [152] , [153] , [154] , [155] , [156] and COVID-19 vaccination [46] , [148] , [157] , [158] , [159] , [160] , [161] , [162] , [163] , [164] , [165] , [166] , [167] , [168] , [169] , [170] , [171] , [172] , [173] , [174] with the onset of cardiovascular symptoms after vaccination normally occurring a few days after vaccination [158] , [160] , [161] , [162] , [174] , [175] . While COVID-19 vaccine induced myocarditis/pericarditis generally fall in the category ACVS, cases in the category PACVS seem to occur too (e.g.…”

Pathogenic pathways and therapeutic targets of inflammation in heart diseases: A focus on Interleukin‐1

“…57 Glucocorticoids and IVIG use have been in patients with vaccine-associated myocarditis and pericarditis. 58 IL-1 blockade with anakinra and rilonacept have also been used in patients with vaccine-associated myocarditis 59 and pericarditis, 60 respectively.…”

Beyond mental stress-induced myocardial ischemia following the COVID-19 vaccine

“…Second, although the incidence of acute myocarditis/ pericarditis following COVID-19 vaccination is extremely low, we should keep alert to this rare complication, particularly in young adults [ 8 , 9 ]. The clinical manifestations of COVID-19 vaccine-related inflammatory heart conditions included chest pain, shortness of breath, fever, elevated cardiac enzymes and diffuse ST-segment elevation on electrocardiogram.…”

“…The clinical manifestations of COVID-19 vaccine-related inflammatory heart conditions included chest pain, shortness of breath, fever, elevated cardiac enzymes and diffuse ST-segment elevation on electrocardiogram. Sometimes, cardiac magnetic resonance imaging can demonstrate the presence of myocardial edema on T2 mapping and late gadolinium enhancement and can help to make a diagnosis [ 9 ]. After treatment with nonsteroidal anti-inflammatory drugs or colchicine with corticosteroids for refractory cases, most patients had a favourable clinical recovery [ 9 ].…”

“…Sometimes, cardiac magnetic resonance imaging can demonstrate the presence of myocardial edema on T2 mapping and late gadolinium enhancement and can help to make a diagnosis [ 9 ]. After treatment with nonsteroidal anti-inflammatory drugs or colchicine with corticosteroids for refractory cases, most patients had a favourable clinical recovery [ 9 ].…”