Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination: What Do We Know So Far?

Abstract

This is a cross-sectional study of 29 published cases of acute myopericarditis following COVID-19 mRNA vaccination. The most common presentation was chest pain within 1–5 days after the second dose of mRNA COVID-19 vaccination. All patients had an elevated troponin. Cardiac magnetic resonance imaging revealed late gadolinium enhancement consistent with myocarditis in 69% of cases. All patients recovered clinically rapidly within 1–3 weeks. Most patients were treated with non-steroidal anti-inflammatory drugs for symptomatic relief, and 4 received intravenous immune globulin and corticosteroids. We speculate a possible causal relationship between vaccine administration and myocarditis. The data from our analysis confirms that all myocarditis and pericarditis cases are mild and resolve within a few days to few weeks. The bottom line is that the risk of cardiac complications among children and adults due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection far exceeds the minimal and rare risks of vaccination-related transient myocardial or pericardial inflammation.

Serious complications of COVID-19 vaccines: A mini-review

“…In June 2021, a possible causal association between SARS CoV-2 mRNA-based vaccines, both BNT162b2 vaccine and mRNA-1273 vaccine, and myocarditis and/or pericarditis, was reported [ 31 ]. Since then, there is increasing evidence thatmyocarditis and pericarditis constitute as rare complications of the mRNA vaccines [ 32 ].…”

“…CDC recommendations clearly outline the benefits of COVID-19 vaccination, which outweigh the rare myocarditis and pericarditis risks and, therefore, it recommends the vaccination for anyone who is 12 years of age and older [ 34 ]. Although the pathophysiological mechanisms of myocarditis development are not clear, molecular mimicry between the viral spike protein and a cardiac protein, as well as induction of immunologic pathways and a non-specific innate inflammatory response have been proposed [ 31 ]. Most patients with post-vaccination myocarditis present retrosternal chest pain, that is often worsened by inspiration and relieved by leaning forward, while some patients develop respiratory distress in addition to the chest pain.…”

“…Most patients with post-vaccination myocarditis present retrosternal chest pain, that is often worsened by inspiration and relieved by leaning forward, while some patients develop respiratory distress in addition to the chest pain. Symptom onset is usually within 2–3 days (range 1–7 days) after the second dose of mRNA vaccination [ 31 ]. Laboratory investigations show elevation in troponin and C-reactive protein levels that are both indicative of myocardial inflammation.…”

“…Treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids; in young patients (≤18 years old), IVIG (along with corticosteroids) has also been administered [ 35 ]. To date, all cases that have been reported in the literature, developed a non-severe disease with complete clinical recovery within 1–3 weeks post myocarditis/pericarditis onset [ 31 , 35 ].…”

The Female Athlete’s Heart: Overview and Management of Cardiovascular Diseases

“…More recently, rare cases of myocardial and pericardial inflammation following COVID-19 vaccination have been reported. [ 54 , 55 ] The Centers for Disease Control and Prevention reported an incidence of 4.8 cases per 1 million between COVID-19 mRNA vaccines and myocarditis, particularly in young men within a few days of the second vaccination. [ 56 ] Pericarditis tended to affect older patients after the first or second dose.…”