Hello, welcome everybody, this is doctor Bolad.
Today I will talk to you about heart muscle inflammation, medically referred to as myocarditis,
that can occur after receiving the COVID-19 vaccine.
For those who are new to my channel, I am a board certified cardiologist and interventional
cardiologist, and here on this channel you will find lots of education about Heart Health
and Heart Disease, so if you are interested, don’t forget to subscribe.
So let us get started with this video of myocarditis related to COVID-19 vaccination.
In the United States, as of the date of recording of this video in January 2022, the authorized
vaccines to protect against COVID-19 infection are two mRNA vaccines, which are the Pfizer
and Moderna vaccines, in addition to a third vaccine which is an adenoviral vector vaccine,
the Janssen COVID-19 vaccine, generally referred to as the J&J vaccine.
The preference is to use the Pfizer or the Moderna vaccines over the J&J vaccine, and
this is based on a more favorable risk-benefit profile with the mRNA vaccines.
The J&J vaccine has been associated with clotting associated with reduced blood platelets count,
in addition to associated with Guillain-Barre syndrome, and the Pfizer and Moderna vaccines
have been associated with myocarditis, which is the inflammation of the muscle of the heart.
The risks of these events are extremely small, and the benefits of all the vaccines outweigh
them.
In this video, I will discuss specifically the myocarditis side effect of the mRNA vaccines.
I have to point out that myocarditis has not been reported after getting the J&J vaccine.
The clinical manifestation of myocarditis is variable.
Many cases of myocarditis likely go undetected, because they are subclinical or present with
nonspecific signs.
When myocarditis manifests clinically, the symptoms range from fatigue to chest pain,
heart failure, cardiogenic shock, arrhythmias, and sudden death.
Myocarditis may be focal, involving only part of the heart muscle, or it may be diffuse,
involving any or all heart chambers.
Severe, diffuse myocarditis can result in acute dilated heart failure.
Myocarditis, and possibly pericarditis which is inflammation of the covering of the heart,
occur mainly in male adolescents and young adults.
In a review of the Vaccine Adverse Event Reporting System, which is a passive surveillance system
in the United States to which patients and providers can submit reports of events, there
were 267 reported cases of myocarditis and pericarditis following one dose of an mRNA
vaccine, and 827 following two doses as of June 2021.
The median ages for events after one dose was 30 years and after two doses was 24 years.
Approximately three-quarters of the cases occurred in males.
The estimated rate of myocarditis or pericarditis among males 12 to 29 years of age was 41 cases
per million following a second dose of an mRNA vaccine.
The estimated rate among females of the same age range was much lower at 4.2 cases per
million and among males more than 30 years was 2.4 cases per million.
Among the cases that have been reported, most were mild.
Onset was generally within the first week after vaccination, more commonly after the
second dose.
Most patients who presented for care responded well to medical treatment and had quick symptom
improvement.
There have been very rare reports of fulminant myocarditis in individuals who received an
mRNA vaccine within the preceding weeks.
The clinical presentation was illustrated in a retrospective study of 139 adolescents
and young adults less than 21 years old with suspected vaccine-related myocarditis based
on elevated blood troponins within 30 days of vaccination without alternative diagnosis.
Almost all presented with chest pain.
The heart function on echocardiogram was normal in 80 percent of patients.
Only two patients required intensive medical therapy.
Median hospital stay was two days, and those with reduced heart function had normalized
function on follow-up.
The possibility of myocarditis should be considered in adolescents and young adults who develop
new chest pain, shortness of breath, or palpitations after receiving an mRNA vaccine.
Regarding children aged 5 to 11 years, the incidence is lower than that mentioned above
for adults.
Regarding the booster dose side effects, the rate and severity of adverse reactions following
booster doses are similar to those reported following the first and second doses.
For mRNA vaccines, local and systemic reactions were reported slightly less frequently after
the booster dose than the second dose.
There were 12 confirmed reports of myocarditis following 26 million mRNA booster doses administered
in the United States.
So far after more than six thousand booster doses in 12- to 15-year-olds, there were no
cases reported of myocarditis in this age group.
For those who develop myocarditis or pericarditis following a first dose of the Pfizer or Moderna
vaccine, I suggest that the second dose be delayed in most cases.
It is reasonable for such individuals to choose to receive a second dose once the episode
has completely resolved if the risk of severe COVID-19 is high.
Individuals with a history of resolved myocarditis or pericarditis unrelated to COVID-19 vaccination,
can receive the Pfizer or Moderna vaccine.
The diagnosis of Myocarditis is based on the following tests:
1- Serum cardiac troponin levels.
These are commonly elevated in patients with myocarditis, particularly those with short
duration of symptoms of less than one month 2- ECG changes can be suggestive of acute
myocardial injury or arrhythmia 3- An echocardiogram in all patients with
suspected myocarditis is needed to evaluate regional and global ventricular function,
valvular function, and other potential causes of cardiac dysfunction.
4- Coronary angiography is indicated in selected patients with clinical presentation indistinguishable
from a heart attack, lifestyle-limiting coronary disease despite medical therapy, or high-risk
features for ischemic heart disease on noninvasive testing.
5- Cardiac magnetic resonance imaging is indicated in patients with suspected myocarditis with
elevated troponin level and/or reduced heart function without a clear cause such as ischemic
heart disease.
Cardiac magnetic resonance imaging often provides supportive evidence of myocarditis.
Treatment of myocarditis includes general measures common to patients with various types
of myocarditis, as well as therapy targeting specific disorders.
Patients with myocarditis should receive standard therapy for acute and chronic heart failure,
including diuretic therapy to remove excess fluid from the body, in addition to beta blockers
and angiotensin converting enzyme inhibitors.
Things to avoid include Pain killers from the nonsteroidal anti-inflammatory group of
drugs, such as ibuprofen, as they are not effective and might increase the heart muscle
inflammatory process and increase the likelihood of death.
Heavy alcohol consumption should also be restricted since heavy alcohol intake may enhance the
severity of myocarditis.
Also, in the acute phase of myocarditis, physical activity should be restricted to reduce the
work of the heart, especially when there is fever, active systemic infection, or heart
failure.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk
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