COVID-19 vaccine-associated myocarditis

Figure 1 Coronavirus disease 2019 vaccine-mediated myocarditis and pericarditis cases reported to Vaccine Adverse Event Reporting System. A: Age. A total of 4317 events of myocarditis and pericarditis after receiving coronavirus disease 2019 (COVID-19) vaccine were reported to Vaccine Adverse Event Reporting System (VAERS) as of December 31, 2021. Age group 18-29 had the highest number of cases reported for myocarditis (763 cases) as well as pericarditis (404 cases). Adapted from centers for disease control and prevention (CDC) WONDER and VAERS which is updated weekly for continuous updates including revisions and new reports for preceding time periods[9]; B: Vaccine manufacturer. A total of 2512 cases of myocarditis and 1805 cases pericarditis after receiving COVID-19 vaccine were reported to VAERS as of December 31, 2021. Pfizer-BioNTech™ had the highest number of cases reported for myocarditis (1615 cases) as well as pericarditis (1063 cases). Adapted from CDC WONDER and VAERS which is updated weekly for continuous updates including revisions and new reports for preceding time periods[11]. COVID-19: Coronavirus disease 2019.

Figure 2 Cardiac magnetic resonance imaging of coronavirus disease 2019 vaccine-associated myocarditis. Cardiac magnetic resonance imaging slice of a 21-year-old male six days after receiving his second dose of the Moderna™ mRNA coronavirus disease 2019 vaccination showing evidence of significant diffuse late gadolinium enhancement and myocardial edema consistent with myocarditis.

Figure 3 Clinical decision-making algorithm for diagnosis and management of suspected coronavirus disease 2019 vaccine-associated myocarditis. ¹All cases should have monitoring with close cardiology follow up. Initial evaluation should include a basic workup in addition to ruling out other etiologies that can present similarly. Early cardiac consultation should occur for suspected coronavirus disease 2019 vaccine myocarditis along with close cardiac monitoring and follow-up. SOB: Shortness of breath; EKG: Electrocardiogram; Echo: Echocardiogram; CXR: Chest x-ray; CBC: Complete blood count; CRP: C-reactive protein; BNP: Brain natriuretic peptide; ESR: Erythrocyte sedimentation rate; CMRI: Cardiac magnetic resonance imaging; EBV: Epstein-barr virus; CMV: Cytomegalovirus; Parvo: Parvovirus; RSV: Respiratory syncytial virus.