Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines

Abstract

Cardiovascular complications following the receipt of mRNA-based (Pfizer-BioNTech and Moderna) coronavirus disease 2019 (COVID-19) vaccines have not yet been described. In this case series, we describe two patients with clinically suspected myocarditis, one patient with stress cardiomyopathy, and two patients with pericarditis after receiving an mRNA-based COVID-19 vaccine. The two patients with clinically suspected myocarditis were otherwise healthy young men who presented with acute substernal chest pressure and/or dyspnea after receiving the second dose of the vaccine and were found to have diffuse ST elevations on electrocardiogram (ECG), elevated cardiac biomarkers and inflammatory markers, and mildly reduced left ventricular (LV) function on echocardiography. Both patients met the modified Lake Louise Criteria for acute myocarditis by cardiac magnetic resonance imaging. We subsequently discuss a case of a 60-year-old woman with known coronary artery disease (CAD) and previously normal LV function, who presented with new exertional symptoms, ECG changes, and apical akinesis following the second dose of the vaccine, and was diagnosed with a stress cardiomyopathy. Finally, we describe two patients with pericarditis who presented with chest pain, elevated inflammatory markers, and pericardial effusions after receiving the vaccine. Overall, this case series describes the first reported cases of myocarditis, stress cardiomyopathy, and pericarditis after receiving an mRNA-based COVID-19 vaccine.

Clinical Presentation and Outcomes of Myocarditis Post mRNA Vaccination: A Meta-Analysis and Systematic Review

“…A few autoantibodies were seen by their significance is unknown [20]. Other authors have also tested for active viral infections including influenza, common respiratory pathogen panel, EBV, CMV, HIV, hepatitis B, C, Coxiella, adenovirus, enterovirus, parvovirus B19, and Mycoplasma without any positive results [1,7,8,10,12,[14][15][16][17][18][19][23][24][25][26][27][28][29]31]. Other proposed mechanisms include molecular mimicry between SARS-COV-2 spike protein and self-antigens and auto-antibody generation leading to myocardial damage [33].…”

A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male

“…There have been several cases of myocarditis and pericarditis in individuals who have received COVID-19 mRNA vaccines. 12 13 14 15 16 17 The reported cases have often occurred within days of vaccination, more frequently among younger males and more commonly following the second dose of vaccines. The course of post-vaccination myopericarditis is generally mild and responds well to conservative treatment like NSAIDs.…”

A Case of Acute Pericarditis After COVID-19 Vaccination

“…To the best of our knowledge, to the submission date, this is the first reported case of acute pericarditis likely related to COVID-19 vaccination in 54 year women. Rare case series of vaccine-related pericarditis have been reported when using mRNA vaccines against COVID-19, particularly in adolescents and young adults (<30 years) and mainly male; symptom onset is usually within 1 week following vaccination (13)(14)(15). Clinical course appears to be mild in most cases, these patients can usually return to their normal daily activities after their symptoms improve (13,14).…”