COVID-19 vaccination and cardiac dysfunction

Abstract

The coronavirus disease 2019 (COVID-19) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 infections has reduced the number of symptomatic patients globally. A case series of vaccine-related myocarditis or pericarditis has been published with extensive vaccination, most notably in teenagers and young adults. Men seem to be impacted more often, and symptoms commonly occur within 1 wk after immunization. The clinical course is mild in the majority of cases. Based on the evidence, a clinical framework to guide physicians to examine, analyze, identify, and report suspected and confirmed cardiac dysfunction cases is needed. A standardized workup for every patient with strongly suspicious symptoms associated with the COVID-19 mRNA vaccine comprises serum cardiac troponin measurement and a 12-lead electrocardiogram (ECG). For patients with unexplained elevation of cardiac troponin and pathologic ECG, echocardiography is recommended. Consultation with a cardiovascular expert and hospitalization should be considered in this group of patients. Treatment is primarily symptomatic and supportive. Deferring a 2^nd dose of the COVID-19 mRNA vaccination in individuals with suspected myocarditis or pericarditis after the 1^st dose is suggested until further safety data become available.

Keywords: COVID-19; Cardiac dysfunction; Echocardiography; Electrocardiography; Myocarditis; Pericarditis; SARS-CoV-2; mRNA vaccine.

Figure 1

Timelines of acute myocarditis occurrence after Pfizer-BioNTech and Moderna mRNA coronavirus disease 2019 vaccination. COVID-19: Coronavirus disease 2019.

Figure 2

Coronavirus disease 2019 mRNA vaccine associated with myocarditis.