Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical Practice

COVID-19: Lessons Learned and a Need for Data Driven Decision Making

“…These generated and propagated fear and vaccine hesitation [16]. Holland and colleagues [5] highlighted the importance of temporal considerations for distinguishing between viral or vaccine induced myocarditis, and investigative approaches that include chest X-ray, 12-lead electrocardiograph (ECG), and high-sensitivity troponin measurements. In addition, further doses of mRNA vaccines in myocarditis cases following mRNA vaccinations are not recommended, while myocarditis of other origins is not a contraindication to receiving vaccinations.…”

“…This includes tackling the inequity and fragility of public health measures inside systems, as well as the pervasive politics of global health neglect [22], and casting a spotlight on larger political-economic systems and institutional conditions that maintain and promote imbalances in power and resource distribution. This also involves investments in increasing health care worker capacity, and comprehensive evaluation of complications such as cardiac involvement in COVID-19 as highlighted by Holland and colleagues [5] and strengthening local health care systems in various parts of the world, notably in low-and middleincome nations. Access to affordable health insurance and paid sick leave are crucial in enabling people to receive medical care and quarantine if infected.…”

“…The prevalence of elevated high sensitive tropnonin T (hs-TnT) has been reported to range from 20-30% among patients hospitalised for COVID-19, and acute myocardial injury has been reported to range from 8-62% [6]. In the context of insufficient evidence on the management of COVID-19 related myocarditis, Holland and colleagues [5] summarised available clinical evidence and guidelines on clinical examinations suggested for persons with COVID-19. Clinical evaluations in persons with COVID-19 have shown elevations in multiple measures of inflammation-interleukin-6 (IL-6), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) [8], and biomarkers of myocardial injury and heart failure-high-sensitive cardiac troponin I (hs-cTnINT-proBNP [9,10].…”

“…Studies addressing the cardiovascular implications of COVID-19 have focussed on hospitalised patients with severe COVID-19 cases [11]. According to Holland and colleagues [5], available evidence suggests that the risks of myocardial involvement and cardiac complications in COVID-19 are low, with an estimated incidence rate of 11 myocarditis cases per 100,000 COVID-19 infections [5]. However, the importance of cardiac biomarker measurements as an initial triage investigation tool in suspected COVID-19 associated myocardial involvement is underscored, while highly sensitive imaging techniques such as cardiac magnetic resonance (CMR) imaging may be reserved for diagnostic confirmatory purposes.…”

Reply to Letter to the Editor Regarding: “Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination”

“…We thank Lampejo and Durkin for their interest in our recent publication, Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical Practice [ 1 ], and for their letter regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) in these clinical settings.…”