Table 2.
Clinical presentation, lab investigations, and diagnostic findings in patients with myocarditis and pericarditis after COVID‐19 vaccine
| Sr. no. | Doma in | References | Clinical features | ECG findings | Lab investigations | Treatment | Echocardiogram findings | Diagnostic criteria (CMR imaging) | Additional comments |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Case series | Marshall et al. 27 | Fatigue, poor appetite, fever of 38.3°C, and pain in the chest and both arms. | Atrioventric ular dissociation with junctional escape and ST elevation |
CRP = 12.3 mg/L, Troponin I = 2.59 ng/ml |
IVIg, IV methylprednisolone, oral prednisone, IV ketorolac | Normal | CMRI demonstrated apical and midchamber lateral wall subepicardial LGE. | Recovered and discharged |
| Acute, persistent chest pain, myalgias, fatigue, weakness, and subjective low‐fevers grade | Diffuse ST elevation | Troponin T = 232 ng/L, CRP = 6.7 mg/dl | IV ketorolac, colchicine, Aspirin | Echocardiogram was normal | CMR showed patchy, midwall LGE along the basal inferolateral wall segment. | Recovered and discharged | |||
| Chest pain. It worsened when lying flat and was associated with left arm pain and paresthesias | T wave abnormalities with diffuse ST elevation | Troponin I = 5.550 ng/ml, CRP = 25.3 mg/L | Ibuprofen | Normal | CMRI showed delayed enhancement at the LV subepicardial basal anterolateral segment and basal to mid‐ventricular inferolateral segments, consistent with myocardial necrosis, evidence of diffuse fibrosis on T1 weighted imaging, and myocardial edema on T2 mapping. | Recovered and discharged | |||
| Chest pain, malaise, arthralgia, myalgia, and subjective fever. It worsened when lying flat and was associated with left arm pain and paresthesias | ST elevation | Troponin T = 1.09 ng/ml, CRP = 12.7 mg/dl | IVIg, methylprednisolone, oral prednisone, Ibuprofen, Aspirin | Normal | CMRI demonstrated edema, hyperemia, and fibrosis. | Recovered and discharged | |||
| Chest pain, sore throat, headache, dry cough, and body aches. He also developed midsternal chest pain that was worse when lying flat and radiated to the left arm | ST‐elevation | Troponin T = 3.21 ng/ml, CRP = 18.1 mg/dl | IVIg. IV methylprednisolone, oral prednisone, Ibuprofen, Aspirin | Normal | CMRI demonstrated diffuse, nearly complete transmural LV free wall gadolinium enhancement. | Recovered and discharged | |||
| Midsternal Chest Pain, malaise, and subjective fever | ST‐segment elevation | Troponin T = 0.01 ng/ml, CRP = 1.8 mg/dl | IVIg, oral prednisone | Normal | LGE, diffuse myocardial edema. | Recovered and discharged | |||
| Pleuritic chest pain and shortness of breath | ST‐segment elevation |
CRP = 12.7 mg/dl, Troponin I = 0.02 ng/ml |
NSAID, famotidine, furosemide | Echocardiogram showed mildly depressed left and right ventricular systolic | LGE (subepicardial) involving mid and apical LV free wall, myocardial edema, hyperemia. | Recovered and discharged | |||
| 2 | Case report | Minocha et al. 30 | Sudden onset of severe, burning left‐sided chest pain that radiated to the left shoulder and the upper left arm. He reported that the chest pain worsened with exertion and movement | Diffuse ST‐segment elevations | Troponin = 2.3 ng/ml, CRP = 29 mg/L | NSAIDs | Not mentioned | CMR showed low normal LVEF (53%), trivial pericardial effusion, and subepicardial lGE. | Recovered and discharged |
| 3 | Case series | Dionne et al. 25 | Chest pain in all fever in 10 patients, myalgia in 8 patients, and headache in 6 patients. | Diffuse ST‐segment elevation present on admission in six patients and at some time during hospital admission in eight patients. Four patients had nonspecific ST‐segment changes. One patient had nonsustained ventricular tachycardia during hospital admission. | Troponin levels were elevated in all patients at admission (median, 0.25 ng/ml [range, 0.08– 3.15 ng/ml]) and peaked 0.1–2.3 days after admission. | Seven patients were treated with IVIg and methylprednisolone (1 mg/kg/dose twice a day, transitioned to prednisone at time of discharge) | Three patients had global LV systolic ventricular dysfunction (EF 44%, 49%, and 53%), one of whom also had regional wall motion abnormality at the apex. Two patients with systolic dysfunction had abnormal diastolic function indices, and one patient with borderline EF (55%) had evidence of diastolic dysfunction. Five patients had abnormal global longitudinal or global circumferential strain. | LGE = 12 patients, Systolic LV dysfunction = 3 patients, Findings consistent with myocarditis = 13 patients. | Recovered and discharged |
| 4 | Case series | Dickey et al. 24 | Positional and pleuritic chest and neck pain; chills; and myalgias | Sinus rhythm with inferolateral ST‐elevation | Troponin I (ng/ml) = 5.41 | Not mentioned | LVEF = 45% | Increased T2 signal and LGE in the midwall of the lateral segments in a patient who received their second SARS‐CoV‐2 vaccination 5 days earlier | Recovered and discharged |
| Pleuritic and positional chest pain; rhinorrhea; headache, fever | Sinus rhythm with diffuse ST‐elevation | Troponin I (ng/ml) = 38.3 | Not mentioned | LVEF = 53% | Increased T2 signal and LGE in the midwall and subepicardial layer throughout the left ventricle) in a patient who received their second SARS‐CoV‐2 vaccination 7 days earlier. | Recovered and discharged | |||
| Pleuritic and positional chest pain; chills; myalgias; and subjective fever | Sinus rhythm with diffuse ST‐elevation | Troponin I (ng/ml) = 18.94 | Not mentioned | LVEF = 58% | Increased T2 signal and LGE in the midwall and subepicardial layer of the mid‐posterolateral segment in a patient who received their second SARS‐CoV‐2 vaccination 6 days earlier. | Recovered and discharged | |||
| Nonpositional chest pain radiating to back; myalgia; malaise, fever | Sinus rhythm with diffuse ST‐elevation and PR depression; nonsustained ventricular tachycardia | Troponin I (ng/ml) = 13.4 | Not mentioned | LVEF = 48% | Not mentioned. | Recovered and discharged | |||
| Pleuritic and positional chest pain; headache | Sinus rhythm with nonspecific T wave abnormalities | Troponin I (ng/ml) = 5.21 | Not mentioned | LVEF = 46% | Not mentioned. | Recovered and discharged | |||
| Nonpositional chest pressure; myalgias | Ectopic atrial rhythm with diffuse ST‐elevation and PR depression | Troponin I (ng/ml) = 19.7 | Not mentioned | LVEF = 50% | Increased T2 signal and LGE in the subepicardial apical and apical lateral segments. | Recovered and discharged | |||
| 5 | Case report | Isaak et al. 26 | Fever, myalgia, and intermittent tachycardia | ST‐segment elevation in the left precordial lead | High‐sensitive cardiac troponin and C‐reactive protein levels were elevated (values not mentioned) | Not mentioned | Normal | Cardiac MRI at 1.5 T showed a normal LV size, a normal LVEF, and a small pericardial effusion. T2‐weighted short inversion time inversion recovery sequences displayed focal myocardial edema involving the lateral wall, most emphasized in the basal inferolateral segment. | Recovered and discharged |
| 6 | Case report | Watkins et al. 28 | Presented with midsternal chest pain that radiated to the left side, mild shortness of breath. | Diffuse concave ST segment elevations with PR depressions. | Troponin = 89 ng/L | Colchicine. Metoprolol, ibuprofen | LVEF = 59% | Bedside ultrasound revealed a small pericardial effusion without evidence of tamponade, which supported the diagnosis. CMR was positive for myocarditis. | Recovered and discharged |
| 7 | Case series | Park et al. 29 | Presented with acute onset, mid‐sternal, nonradiating chest pain associated with chest tightness | ST‐elevation and T wave inversion in lateral leads | Troponin T = 304 ng/L, CRP = 18.5 mg/L | Not mentioned | LVEF = 55%–60%, with basal inferior and basal inferolateral hypokinesis | CMR revealed LGE involving the basal inferior, basal to mid inferolateral, mid anterolateral, apical lateral, apical septal, and apical inferior wall segments in a subepicardial distribution pattern, consistent with myocarditis. | Recovered and discharged |
| Presented with acute onset, mid‐sternal, nonradiating chest pain associated with chest tightness | ST‐segment elevation in inferolateral leads, T wave inversion | Troponin T = 431 ng/L, CRP = 24.3 mg/L | Intravenous Ig | LVEF of 45% with moderate hypokinesis of the apex and apical septum | Lab findings. | Recovered and discharged |
Abbreviations: CMRI, cardiac magnetic resonance imaging; CRP, C‐reactive Protein; ECG, electrocardiogram; IV, intravenous; IVIg, intravenous immunoglobulins; LGE, late gadolinium enhancements; LVEF, left ventricular ejection fraction; NSAIDs, nonsteroidal anti‐inflammatory drugs.