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World J Cardiol. Jun 26, 2022; 14(6): 343-354
Published online Jun 26, 2022. doi: 10.4330/wjc.v14.i6.343
COVID-19 vaccination and cardiac dysfunction
Wattana Leowattana, Tawithep Leowattana
Wattana Leowattana, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
Author contributions: Leowattana W wrote the paper; Leowattana T collected the data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wattana Leowattana, MD, MSc, PhD, Professor, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi road, Rajatawee, Bangkok 10400, Thailand. wattana.leo@mahidol.ac.th
Received: January 15, 2022
Peer-review started: January 15, 2022
First decision: March 16, 2022
Revised: March 27, 2022
Accepted: May 17, 2022
Article in press: May 17, 2022
Published online: June 26, 2022
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 2nd dose of the COVID-19 mRNA vaccination in individuals with suspected myocarditis or pericarditis after the 1st dose is suggested until further safety data become available.

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

Core Tip: A possible hypersensitivity myocarditis with a consistent relationship to administering an mRNA coronavirus disease 2019 (COVID-19) vaccination was reported. While the actual prevalence of this adverse event is unclear at this time, the clinical manifestation and pathological findings point to a link with an inflammatory reaction to a COVID-19 immunization. However, acute myocarditis following mRNA COVID-19 vaccination was very low and mostly self-limited. Moreover, the high efficacy of mRNA COVID-19 vaccines in preventing further pandemic conditions, reducing disease severity, and the occurrence of a very low incidence of myocarditis following immunization should be a strength of an mRNA COVID-19 vaccine for public trust.