Acute Myocarditis and Pericarditis After mRNA COVID-19 Vaccinations—A Single-Centre Retrospective Analysis

Marina Wassif, Phillip Lo, Paul Satouris, Lucinda Swan, Daniel Tardo, Jason C. Kovacic, David Muller, Kavitha Muthiah, Eugene Kotlyar, Nicole K. Bart

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: With the rapid rollout of COVID-19 vaccinations, numerous associated and suspected adverse events have been reported nationally and worldwide. Literature reporting confirmed cases of pericarditis and myocarditis following SARS-CoV-2 mRNA vaccinations has evolved, with a predominance in adolescent males following the second dose. Methods: This was a retrospective analysis of all patients presenting to St Vincent's Hospital, Sydney, Australia with suspected COVID-19 vaccine-related myocarditis and pericarditis. The Brighton Collaboration Case Definitions of Myocarditis and Pericarditis were used to categorise patients into groups based on diagnostic certainty. Cardiac magnetic resonance imaging findings were reviewed against updated Lake Louise Criteria for diagnosing patients with suspected myocarditis. Results: We report 10 cases of confirmed, possible or probable myocarditis and pericarditis. The mean age of presentation in the vaccine group was 33±9.0 years. The most common presenting symptom was pleuritic chest pain (n=8, 80%). Eight patients (80%) had electrocardiogram (ECG) abnormalities (n=6 pericarditis, n=2 myocarditis). Five patients (50%) had a minimum 24 hours of cardiac monitoring. One patient had multisystem inflammatory syndrome following vaccination (MIS-V) with severely impaired left ventricular ejection fraction and required admission to the intensive care unit. Discussion and Conclusion: Cardiac complications post mRNA vaccines are rare. Our case series reflects the worldwide data that vaccine-related myocarditis and pericarditis most frequently occur in young males, following the second dose of the vaccine. These cardiac side effects are mild and self-limiting, with adequate responses to oral anti-inflammatories. One patient developed a severe reaction, with no fatal cases.

Original languageEnglish
Pages (from-to)467-479
Number of pages13
JournalHeart Lung and Circulation
Volume32
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • Multisystem inflammatory syndrome following vaccination (MIS-V)
  • Myocarditis
  • Pericarditis
  • mRNA COVID vaccination

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