Symptomatic Myocarditis Post COVID-19 Vaccination

Abstract

There are few major adverse events after the coronavirus disease 2019 (COVID-19) vaccination. However, increasing cases of myocarditis and pericarditis are being reported to the Vaccine Adverse Event Reporting System (VAERS) in young people, primarily after the second dose of messenger RNA (mRNA) COVID-19 vaccines. We present a case series of myopericarditis post mRNA (Moderna) and myocarditis post vector-based (Johnson & Johnson) COVID-19 vaccines. We intend to highlight the importance of early diagnosis and treatment of vaccine-related myocarditis to reduce mortality and morbidity.

Keywords: covid-19; johnson & johnson; moderna; myocarditis; vaccine; vaccine adverse event reporting system.

Figure 1. Electrocardiogram of Patient 1

Diffuse ST elevations (circled), with an RSR’ in V1 and V2.

Figure 2. Cardiac Magnetic Resonance Imaging of Patient 1

Sort axis post-contrast image depicting pericardial enhancement (red arrows) adjacent to the right ventricle free wall and the lateral left ventricle wall.

Figure 3. Electrocardiogram of Patient 2

Normal sinus rhythm with an incomplete right bundle branch block (circle).

Figure 4. Cardiac Magnetic Resonance Imaging Findings Demonstrative of Myocarditis of Patient 2

Cardiac MRI A-C for patient 2; A) Late gadolinium enhancement imaging (PSIR-LGE) demonstrative of confluent mid-wall and subepicardial myocardial fibrosis in the basal-anterior, basal-septal, and basal-inferior walls. B) T2 parametric map demonstrative of elevated myocardial T2 values in the same distribution as myocardial fibrosis. C) Extracellular volume (ECV) parametric mapping demonstrative of elevated myocardial ECV in the anterior, septal, and inferior walls. The presence of T1 and T2 changes fulfills the Lake Louise criteria to establish a diagnosis of myocarditis.