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.

Keywords: COVID-19 vaccine; myocarditis; pericarditis.

Figure 1

CDC working case definition for acute myocarditis. Modified from source: http://www.cdc.gov; accessed 18 June 2021.

Figure 2

CDC working case definition for acute pericarditis. Modified from source: http://www.cdc.gov; accessed 18 June 2021. * Typically described as pain made worse by lying down, deep inspiration, or cough and relieved by sitting up or leaning forward, although other types of chest pain may occur.