Myopericarditis in a teenager following first mRNA COVID vaccine dose: the role of multi-parametric cardiovascular magnetic resonance

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.

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COVID-19 Vaccine–Related Myocardial and Pericardial Inflammation

Furqan

Chawla

Majid

et al. 2022

Curr Cardiol Rep

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Tozinameran

2022

Reactions Weekly

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Myopericarditis: case reportA 16-year-old boy developed myopericarditis following administration of tozinameran for COVID-19 vaccination. The boy presented with severe, stabbing chest pain, which exacerbated by lying supine and relieved by sitting forward. His chest pain was associated with fever and myalgias, which developed 3 days after administration of first dose of tozinameran [Pfizer-BioNTech SARSCoV-2 mRNA vaccine; route and dosage not stated] for COVID-19 vaccination. The ECG revealed ST-segment elevation in the inferolateral leads and PR segment depression, which was suggestive of pericarditis and mild left ventricular systolic dysfunction (ejection fraction 48%). Further investigations showed elevated Troponin T levels. The Cardiovascular magnetic resonance (CMR) imaging was performed after 5 days, which demonstrated mild left ventricular systolic dysfunction, with elevated myocardial T1 (1263 ms) and T2 (65ms) the basal to mid-inferior and lateral segments, consistent with myocardial oedema and fibrosis, with increased extracellular volume and corresponding sub-epicardial late gadolinium enhancement. Thus, myopericarditis associated with mRNA-COVID vaccination was confirmed.The boy received guideline-based heart failure medications including bisoprolol and ramipril along with unspecified analgesia. He was kept on cardiac monitoring for 72 hours. His further course was uneventful. On discharge, his troponin levels were downtrending and he was pain free. In view of potential risk of myocarditis recurrence, he was advised against a further dose of tozinameran.

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Analysis of immunological and biochemical parameters after booster dose vaccination using protein-based and inactivated virus vaccine for safety

Malek,

Fallah Mehrabadi,

Es-haghi

et al. 2024

Heliyon

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Myopericarditis in a teenager following first mRNA COVID vaccine dose: the role of multi-parametric cardiovascular magnetic resonance

Abstract: A 16-year-old male develops myopericarditis three days after a first mRNA COVID vaccine associated with mild left ventricular systolic dysfunction and evidence of myocardial fibrosis and oedema on multiparametric cardiac magnetic resonance imaging.

Cited by 6 publications

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COVID-19 Vaccine–Related Myocardial and Pericardial Inflammation

COVID-19 Vaccine–Related Myocardial and Pericardial Inflammation

Tozinameran

Analysis of immunological and biochemical parameters after booster dose vaccination using protein-based and inactivated virus vaccine for safety

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