Skip to main content
. 2022 Mar 11;76:103486. doi: 10.1016/j.amsu.2022.103486

Table 3.

Clinical Presentation, Lab investigations and Diagnostic findings in patients with myocarditis and pericarditis after COVID-19 vaccine.

Sr No Domain Author, Year Clinical features ECG Findings Echocardiogram findings Lab Investigations Treatment Diagnostic Criteria (CMR imaging findings) Additional Comments
1 Case report Cimaglia et al. (2021) [29] Chest pain exacerbated by deep breathing and supine position ST elevation in I, II and aVF, mild ST depression in V1 to V3 LVEF 45% Cardiac troponin T 1204 ng/L, C-reactive protein (1.9 mg/dL) Anti-inflammatory therapy Mildly dilated LV with normal EF and no regional kinesis abnormality Recovered and discharged
2 Case report Nguyen et al.(2021) [48] Fever, myalgia, fatigue, and growing mid-sternal burning chest pain without radiation 12 h after vaccine administration Normal ECG LVEF = 53–56% Cardiac troponin T (333 pg/mL). C-reactive protein (19.6 mg/L) Not mentioned Subepicardial and intramural LGE in mid and basal inferolateral segment indicating myocardial edema Recovered and Discharged
3 Case report Watkins et al. (2021) [14] Midsternal chest pain radiating to the left side ST-segment elevations with PR depressions (V5–V6, II, aVF). LVEF 59% Troponin increased to a maximum of 108 ng/L. Colchicine, metoprolol, and ibuprofen. CMR positive for myocarditis Recovered and Discharged
4 Case series Vidula et al. (2021) [44] Acute substernal chest pressure, dyspnea Diffuse ST elevations LVEF: 47%; NOT significant Lisinopril and metoprolol succinate CMR revealed mild hypokinesis of the basal to mid-lateral wall with elevated corresponding T1 value, elevated T2 value and sub-epicardial delayed enhancement in the lateral wall. Recovered and Discharged
fever, myalgia, acute substernal chest pain Diffuse ST elevations LVEF: 59%, High-sensitive troponin: 7206 ng/L, CRP: 74.2 mg/L Discharged on metoprolol succinate and a course of colchicine and ibuprofen. Subepicardial LGE involving the mid-lateral wall, with corresponding elevated native T1 and T2 values Recovered and Discharged
History of the stent in LAD(left anterior descending artery) Diffuse ST-elevation LVEF = 44% Troponin T: 0.129 ng/mL Metoprolol succinate and lisinopril Not performed Recovered and Discharged
Chest pain that worsened during inspiration and while supine Not mentioned LVEF: 60%; pericardial effusion Troponin T: undetectable.CRP: 72.6 mg/L Colchicine Cardiac MRI not performed Recovered and discharged
Fever, night sweats, chest discomfort, palpitations Not mentioned LVEF: 65%; pericardial effusion Troponin T: undetectable.CRP: 23.1 mg/dL Colchicine Cardiac MRI not performed Recovered and Discharged
5 Case report Albert et al. (2021) [43] Substernal chest pain exacerbated with deep inspiration and supine position Normal ECG within normal range, with LVEF within 65% Elevated troponin I (18.94 ng/mL), elevated C Reactive Protein (26.4 mg/L) Discharged on Beta blocker Normal LV size and EF (58%), mid-myocardial and epicardial edema. Recovered and Discharged
6 Case series Shaw et al. (2021) [32] Chest pain Not mentioned Not mentioned Troponin I elevated to 4.963 ng/mL Not mentioned CMR demonstrated LVEF = 56%. epicardial edema No follow-up mentioned
Chest pain Not mentioned Not mentioned Troponin I elevated to 7.961 ng/mL (normal <0.034 ng/mL) Not mentioned CMR demonstrated LVEF = 57%, On T2 mapping, there were skip areas of epicardial edema involving the basal inferior, basal, mid, and apical lateral segments (59 ms–66 ms, normal <55 ms) and nonischemic myocardial injury on native T1 mapping (1117 ms-1137 ms, normal 950 ms-1050 ms). Epicardial fibrosis was observed on LGE imaging and interstitial expansion by extracellular volume fraction mapping (40%–44%, normal <28%). No follow-up mentioned
Chest pain Not mentioned Not mentioned Troponin I 4.35 ng/mL Not mentioned CMR demonstrated LVEF = 64%, epicardial edema No follow-up mentioned
Chest pain ST-segment elevation Not mentioned Troponin I 5.41 ng/mL Not mentioned CMR demonstrated LVEF 54%, epicardial and mid wall edema No follow-up mentioned
7 Case report Habib et al. (2021) [28] Presented with chest pain preceded by generalized body aches, fever, chills, and headache for one-day Mild ST-segment elevation Ejection fraction (EF = 57%). Troponin T (troponin T = 1138 ng\L). The patient was started on dual antiplatelets, therapeutic anticoagulation, and metoprolol. After ruling out coronary artery disease at first, the received paracetamol IV for chest pain. CMR revealed an early and late faint subepicardial enhancement of the basal lateral Recovered and Discharged
8 Case series Abbate et al. (2021) [34] Presented in cardiogenic shock ST-segment elevations LVEF 20% CRP(13.1 mg/dL), Immunosuppressive Therapy Methylprednisolone 1000 mg Not mentioned died due to recurrent cardiac arrest and refractory shock
Fever, cough, chest pain, nausea, and vomiting, hypotension and tachycardia Not significant LVEF of 15% CRP 5.6 mg/dL Immunosuppressive Therapy: Methylprednisolone LVEF of 35%, small pericardial effusion, delayed enhancement after gadolinium at CMR Recovered and discharged from the hospital after 73 days
9 Case series Mouch et al. (2021) [19] Chest pain Diffuse ST elevation, Inverted T lead III Normal CRP - 58.1 mg/L; Troponin T - 589 ng/L; NSAID and colchicine T2 showed mild myocardial edema of the basal septum and inferolateral wall. Subepicardial and mid myocardial LGE of the same affected segments Recovered and Discharged
Chest discomfort ST elevation V2-6, sinus tachycardia LVEF of 50–55% CRP level was 100.0 mg/L, Troponin T - 1062 ng/L. Ibuprofen and colchicine T2 sequence showed mild myocardial edema with LGE in the subepicardial region of the basal and middle anterolateral and inferolateral walls Recovered and Discharged
Chest pain Diffuse ST elevation, Diffuse PR depression Normal study CRP - 86.0 mg/L, Troponin T - 876 ng/L NSAID and colchicine T2 sequences showed mild diffuse myocardial edema and LGE of the basal, inferolateral, anterolateral and anteroseptal walls Recovered and discharged
Chest pain ST elevation: I, aVL, V3-5Inverted T, ST depression:III, aVF LVEF- 50–55%. CRP - 56.2 mg/L, Troponin T - 392 ng/L Ibuprofen and Colchicine LVEF 50–55%, T2 sequence showed subepicardial edema of the middle anterolateral, inferolateral and of the apical anterior walls with LGE of the affected walls Recovered and discharged
Chest pain ST elevation V2-4 Normal CRP -1.6 mg/L, troponin-I 14350 ng/L Ibuprofen and Colchicine LVEF 59%, mid myocardial and subepicardial edema of the basal inferolateral and middle anterolateral segments. LGE present in the same segments Recovered and Discharged
Chest pain ST elevation I II aVL, V2–6SI QIII TIII Normal CRP - 54.7 mg/L, Troponin T 1130 ng/L Ibuprofen and Colchicine T2 sequence showed subepicardial edema of the basal inferolateral, middle inferolateral and infero-septal and apical lateral, anterior and inferior walls. LGE present in the same segments and mid-myocardial enhancement of the middle inferolateral and anterolateral and apical anterior and lateral walls. Recovered and Discharged
10 Case report Ammirati et al.(2021) [45] Chest pain Minimal ST elevation on precordial leads with peaked T waves Not mentioned Troponin T 289 ng/L, and C-reactive protein 2.9 mg/L NSAIDs LVEF (63%), There was focal subepicardial-intramyocardial on LGE involving the basal and apical segments of the infero-lateral wall, colocalized with signs suggestive for edema on T2 weighted images Recovered and Discharged
11 Case report Cereda et al. (2021) [51] Fever and cardiac sounding chest pain Diffuse ST elevation with slightly widened QRS Normal Troponin I: 6.53 ng/mL, C-reactive protein: 2.4 mg/dL Bisoprolol and ramipril (beta-blocker + ACEi) Epicardial edema and nonischemic delayed enhancement Recovered and Discharged
12 Case series Chamling et al. (2021) [21] Acute chest pain with radiation to her left shoulder No ST elevation NOT significant C-reactive protein [mg/L]: <0.6. cardiac troponin-T (hsTrop-T): elevated aspirin, β-Blocker, ACE inhibitor, statine were prescribed on admission LV-EF [%]:67 Follow-up not mentioned
Chest discomfort ST-segment elevations II, III, aVF NOT significant C-reactive protein [mg/L]:<0.08 with elevated hsTrop-T Not mentioned LV-EF [%]: 57 No follow-up mentioned
Chest pain ST-segment elevations II, III, aVF Normal C-reactive protein [mg/L]:13.2 with elevated hsTrop-T Not mentioned LV-EF [%]: 61, No follow-up mentioned
13 Case report D'Angelo et al.(2021) [52] Dyspnea, constrictive retrosternal pain, nausea, and profuse sweating Subtle ST-segment elevation Preserved ejection fraction, mild pericardial effusion Cardiac troponin I (12,564.80 pg/mL), C-reactive protein (39.6 mg/L). Bisoprolol, acetylsalicylic acid, prednisolone. LGE showed subepicardial enhancement of the myocardium Recovered and Discharged
14 Case report Deb et al. (2021) [18] Dyspnea, fever, and chills, nausea, orthopnea, and increasing fatigue Not significant LVEF: 50%–54% Troponin of 180.8 ng/L, CRP: 15.5 mg/Dl Diuretics and supplemental oxygen therapy NOT mentioned Recovered and Discharged
15 Case series Dickey et al. (2021) [30] Positional and pleuritic chest pain, neck pain, chills and myalgias Inferolateral ST elevation Ejection fraction: 45% Peak cardiac troponin I(ng/ml): 5.41 Not mentioned CMR revealed patchy mid myocardial increased T2 signal with corresponding late gadolinium enhancement consistent with the acute inflammation of myocarditis Recovered and Discharged
Pleuritic and positional chest pain, rhinorrhea, headache and fever with 3 days into hospitalization. Diffuse ST elevation Ejection fraction: 53% Peak cardiac troponin I(ng/ml): 38.3 Not mentioned CMR revealed patchy midmyocardial increased T2 signal with corresponding late gadolinium enhancement consistent with the acute inflammation of myocarditis Recovered and Discharged
Pleuritic and positional chest pain, chills, myalgias and subjective fever Sinus rhythm with diffuse ST elevation Ejection fraction: 58% Peak cardiac troponin I(ng/ml): 18.94 Not mentioned CMR revealed patchy midmyocardial increased T2 signal with corresponding LGE consistent with the acute inflammation of myocarditis Recovered and Discharged
Chest pain radiating to back, myalgia, malaise and fever Sinus rhythm with diffuse ST elevation Ejection fraction: 48% Peak cardiac troponin I(ng/ml):13.4 Not mentioned CMR revealed patchy midmyocardial increased T2 signal with corresponding LGE consistent with the acute inflammation of myocarditis Recovered and Discharged
Pleuritic and positional chest pain, headache NOT significant Ejection fraction: 46% Peak cardiac troponin I(ng/ml):5.21 Not mentioned CMR revealed patchy midmyocardial increased T2 signal with corresponding LGE consistent with the acute inflammation of myocarditis Recovered and Discharged
Non-positional chest pain and myalgias Ectopic atrial rhythm with diffude ST elevation Ejection fraction: 50% Peak cardiac troponin I(ng/ml):19.7 Not mentioned CMR revealed patchy midmyocardial increased T2 signal with corresponding LGE consistent with the acute inflammation of myocarditis Recovered and Discharged
16 Case report Ehrlich et al. (2021) [36] Fever, headache, chest pain and dyspnea. Sinus rhythm Ejection fraction: 45% Troponin T concentration of 952 ng/L, elevated C-reactive protein (50.9 mg/L) Therapy with acetylsalicylic acid, unfractionated heparin, an ACE inhibitor, a beta-blocker, and a mineralocorticoid antagonist was started. Cardiac MRI revealed increased left ventricular wall thickness with a septal thickness of 16 mm at maximum and a persistent myocardial inflammation throughout the left ventricle: myocardial hyper-intensities on T2w images indicating myocardial edema were detected in the left ventricle, primarily in the basal and mid inferoseptal and anterolateral segments as well as in the apical lateral segment Recovered and Discharged
17 Case report Hasnie et al. (2021) [39] Sharp substernal non-radiating chest pain, generalized body aches, and a subjective fever Diffuse ST elevation. LVEF: 50–55% High sensitivity troponin was 13,702 ng/L Aspirin, colchicine, metoprolol Normal LVEF (58%), Mild adjacent pericardial LGE Second dose administered with a course of NSAIDs
18 Case series Hudson et al. (2021) [33] Worsening myalgias and fevers, chills, nausea, vomiting, and 24 h of worsening midline, substernal burning that was worse when lying flat. J‐point elevation in lateral leads with widened QRS complex Normal Troponin:1.5 ng/mL (<0.09), C‐reactive protein: 3.6 mg/dL Aspirin and colchicine CMR Not mentioned. Recovered and Discharged
presented to the ED with 3 days of worsening chills, low‐grade fevers, and chest pain Normal ECG Normal Troponin:1.05 ng/mL (<0.09), C‐reactive protein: 3.6 mg/dL (<0.9 mg/dL). Aspirin and colchicine, and ibuprofen CMR not mentioned. Recovered and Discharged
19 Case series Larson et al. (2021) [17] Fever, chills, mylagia on day +1, followed by chest pain day +3 Diffuse ST segment elevation with depression in aVR LVEF: 50%, Peak Troponin: 285 ng/L, CRP:4.8 mg/dL NSAIDs, prednisone Patchy subepicardial delayed enhancements Recovered and Discharged
Fever, chills, mylagia on day +1, chest pain, dyspnea on day +3 Normal ECG LVEF: 34%, generalized hypokinesis Peak Troponin: 46 ng/L, CRP: 14 mg/dL Not mentioned Patchy subepicardial and midmyocardial delayed enhancements Recovered and Discharged
Chest pain Diffuse ST segment elevation LVEF: 47%, Peak Troponin: 520 ng/L, CRP: 9.5 mg/dL Prednisone, colchicine Edema, delayed enhancement, pericardial effusion Recovered and Discharged
Presented with chest pain Diffused peak T wave LVEF: 60%, inferiorlateral hypokinesis Peak Troponin: 37 ng/L, CRP: 5.8 mg/dL Not mentioned Edema, delayed enhancement Hemodynamically stable
Cough, fever on day+1 and chest pain on day +3 Inferolateral ST elevation LVEF: 60%, inferior wall hypokinesis Peak Troponin: 100 ng/L, CRP: 1 mg/dL Colchicine Edema, delayed enhancement, pericardial effusion Non sustained ventricular tachycardia(NSVT) episodes; discharged stable
Fever on day +1 and chest pain on day +2 Diffuse ST segment elevation LVEF: 50%, lateral and inferolateral hypokinesis Peak Troponin: 29 ng/L, CRP: 9 mg/dL NSAIDs Edema, delayed enhancement NSVT episodes; discharged stable
Fever on day +1 and chest pain on day +4 Diffuse ST segment elevation LVEF: 54%, inferior and posterolateral hypokinesis Peak Troponin: 1164 ng/L, CRP: 4.6 mg/dL NSAIDs Edema, delayed enhancement, pericardial effusion and pericardial edema NSVT episodes; discharged stable
Chest pain on day 2 Inferolateral ST elevation LVEF: 53%, in inferolateral hypokinesis Peak Troponin: 1433 ng/L, CRP: 4 mg/dL Not mentioned Edema, delayed enhancement NSVT episodes(N = 3); discharged table
20 Case Report Khogali et al. . 2021 [46] High-grade fever, fatigue, myalgia and headache. multi-organ failure, deranged liver function and DIC Diffuse ST elevation and short PR interval Ejection fraction (EF) of 27% increase in pericardial effusion, and signs of impending cardiac tamponade. Troponin T increased from 98 ng/L reaching up to 1632 ng/L, CRP = 53.7 mg/L Dobutamine, colchicine, and aspirin CMR not mentioned Admitted to ICU due to hemodynamic instability and the presence of combined hypovolemic, obstructive and cardiogenic shock. However recovered after 3 weeks and was discharged.
21 Case Report Kim et al. . 2021 [16] Chest pain that was not related with effort or labor; an atypical dull nature on the substernal area, and non-radiating and constant discomfort. Myalgias, fatigue Mild ST-segment elevation in leads I, II,aVF, and V2-6 Minimal pericardial effusion. GLS bulls map revealed the worsened strain value in basal inferior and inferolateral segments, particularly in epicardium than endocardium. Troponin-I 2.28 ng/mL, C-reactive protein 7.7 mg/dL Symptomatic therapy Abnormal findings on CMR, the subepicardial pattern of LGE in basal inferior and inferolateral segment Recovered and discharged
22 Case Series King et al. . 2021 [23] Chest pain Diffuse ST elevation and downsloping PR depressions LVEF = 55–60%, with basal inferior and basal inferolateral hypokinesis Troponin of 14,045 pg/mL and an elevated CRP. Specific Treatment not mentioned 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. Discharged on 3rd day of hospitalization
Viral prodrome followed by chest pain Diffuse ST elevations; downsloping PR depressions LVEF of 45%moderate hypokinesis of the apex and apical septum. Troponin-I was 22,638 and CRP was markedly elevated Specific treatment not mentioned Outpatient CMR is pending Chest pain resolved the following day. He was discharged on hospital day 3.
Chest pain Diffuse ST elevations with no PR depressions EF = 55% Initial troponin-I was 3785 pg/mL and CRP was notably elevated. Specific treatment not mentioned An autoimmune workup showed an anti-nuclear antibody titer of 1:80 in a speckled pattern and negative double stranded DNA, rheumatoid factor, ribonucleic protein IgG, scleroderma-70, anti–Sjögren's-syndrome-related antigen A, and anti-Smith autoantibodies were negative Discharged the following day
Chest pain T-wave inversions in the lateral leads that resolved on follow up ECG Normal Troponin-I was 2447 pg/mL and CRP was notably elevated. Specific treatment not mentioned Stabilized on same day and discharged on 3rd day
23 Case series Koizumi et al. . 2021 [35] Worsening chest pain ST-elevation leads II, III, aVF and V3–6 Based on ECG and Labs findings High-sensitivity troponin T (hsTnT) (0.906 ng/mL). (NSAID) administration (ibuprofen 600 mg/day Endomyocardial biopsy showed no inflammatory cell infiltration Recovered and Discharged
Worsening chest pain Slight ST elevation NOT significant hsTnT (0.290 ng/mL NSAID administration (ibuprofen 600 mg/day) Cardiac MRI demonstrated LGE in the epicardial to the mid-wall in the left ventricle inferolateral wall Recovered and Discharged
24 Case series Mansour et al. . 2021 [15] Fever and chills, Six hours later, developed substernal chest pain Mild concave ST elevations LVEF = 55% Elevated troponin I of 14 ng/mL,(CRP) of 25 ng/mL (normal 0–0.5 ng/mL), CRP 25 ng/mL, ESR 25 mm/h. Specific treatment not mentioned Subepicardial LGE in the anterolateral wall of the mid and apical left ventricle. Chest pain resolved. Patient discharged on day 3
Light headedness. Two days later, developed retrosternal chest pain Diffuse, mild concave ST elevations and PR depressions without reciprocal changes LVEF = 50% Elevated troponin I of 2.3 ng/mL, CRP of 8 ng/mL. Specific treatment not mentioned Subepicardial enhancement in the inferolateral wall at the base. The patient's symptoms resolved the next day and her troponin declined to 1.3 ng/mL. The patient improved clinically and was discharged home on metoprolol.
25 Case Report Matta et al. . 2021 [42] Sharp, central, non-radiating chest pain associated with fatigue Normal sinus rhythm without any ST-T changes. EF = 60% Elevated troponin I (0.245 ng/mL) and C-reactive protein (44.2 mg/L). Aspirin 325 mg oral once CMR not mentioned. Patient stablilized and discharged the next day
26 Case Report Muthukumar et al. . 2021 [27] High fevers, shaking chills, myalgias, and a headache. Sinus rhythm with left axis deviation and incomplete right bundle-branch block without ST or T wave changes LVEF = 54% Troponin I peaked at 6770 ng/L, C-reactive protein elevated Low-dose lisinopril and carvedilol, Midmyocardial and subepicardial linear and nodular LGE in the inferoseptal, inferolateral, anterolateral, and apical walls At the time of discharge, the patient remained asymptomatic, and his high-sensitivity cardiac troponin T levels had fallen to 138 ng/L. His NT-proBNP (N-terminal pro-B-type natriuretic peptide) at discharge was <27 pg/mL.
27 Case Report Nassar et al. . 2021 [26] Developed dyspnea Sinus tachycardia with a heart rate of 125bpm and T-wave inversions in leads V4–V6 without any ST-segment change 2+ aortic regurgitation and diffuse left ventricular hypokinesis with severely decreased LVEF = 10% Troponin [1.260–2.050 ng/mL], Multiple vasopressors + Antibiotics The diagnostic monitoring via Swan-Ganz catheter revealed a pulmonary wedge pressure (PWP) of 14 mmHg The patient declined cardiac catheterization and remained on medical therapy until her death on the eighth day of admission.
28 Case Series Nevet et al. . 2021 [38] Acute fever and chest pain Diffuse ST elevations Normal Elevated inflammatory markers and myocardial enzymes Colchicine and Ibuprofen Edema and gadolinium enhancement of the myocardium were evident in cardiac magnetic resonance imaging, confirming the diagnosis of myocarditis rapid clinical and laboratory improvement.
29 Case series Patel et al., 2021 [31] Chest pain, Headache, generalized malaise Diffuse PR segment depression and PR segment elevation in lead aVR LVEF = 55% Serum TnI (ng/ml) = 37 C-reactive protein (mg/l) = 50 Aspirin and colchicine Subepicardial LGE and myocardial edema in the basal inferior, basal inferolateral, and apical lateral LV segments. discharged home in stable clinical condition after 48 h of observation
Chest pain, Dyspnea, Nausea, emesis Sinus tachycardia without any ST-T abnormalities LVEF = 62% a Serum TnI (ng/ml) = 49 C-reactive protein (mg/l) = 109 Colchicine and high-dose ibuprofen CMR showed subepicardial LGE in the basal inferolateral segment. Diagnosed with myopericarditis, Discharged in stable condition
Chest pain, Dyspnea, Generalized body aches, nausea, headache, chills, and fatigue Diffuse PR segment depression and PR segment elevation in lead aVR, consistent with acute pericarditis LVEF = 60% Serum TnI (ng/ml) = 17 C-reactive protein (mg/l) = 96 Colchicine Subepicardial LGE and myocardial edema.) Discharged in stable condition
Chest pain, Fever, diaphoresis, rigors, nausea, myalgia, headache, fatigue ST elevations in the lateral leads and ST depression in lead V1. LVEF = 65% Serum TnI (ng/ml) = 26 ESR 32 mm/h None CMR showed subepicardial LGE, myocardial edema. Patient was home without any medications with cardiology follow up.
Chest pain and dyspnea PR segment depression and PR segment elevation LVEF = 51% Troponin I = 58 pg/mL Colchicine, ibuprofen, lisinopril, and metoprolol tartrate CMR showed subepicardial and mid-myocardial LGE in the basal, mid, and apical lateral segments accompanied by myocardial edema in mid and apical lateral segments on T2-weighted images Recovered and Discharged
30 Case series Rosner et al., 2021 [2] Chest pain at rest, nonpleuritic, non- exertional; no fevers, cough- ing, or dyspnea ST elevation LVEF = 51%, mid global hypokinesis Cardiac trop I 17.08 ng/mL Beta blockers, ACE inhibitors Patchy mid subepicardial LGE Recovered and Discharged
Chest pain associ- ated with dyspnea; worse when lying flat and with inspiration PR depression in II, aVF, V4–V6, T wave inversion V1 LVEF = 35–40% Cardiac troponin I ng/mL peak = 11.01, C-reactive protein peak, mg/dL = 1.3 β-blocker, angioten- sin-converting en- zyme inhibitor, aspi- rin, and clopidogrel Patchy mild sub- epicardial LGE, No definitive edema Recovered and Discharged
Fever, chills, dyspnea, and chest heaviness/pain symptoms Not significant LVEF = 61% Cardiac troponin I ng/mL peak = 13, C-reactive protein peak, mg/dL = 5.1 β-blocker, angio- tensin receptor blocker, statin Left ventricular ejection fraction = 56% (no region- al wall motion abnormalities) LGE = Subepicardial LGE, no pericardial thickening or ef- fusion Recovered and Discharged
Intermittent, positional chest pain with left arm numbness and tingling Not signficant LVEF = 53% Cardiac troponin I ng/mL peak = 0.37, C-reactive protein peak, mg/dL = 11.70 3 days IV steroids Left ventricular ejection fraction = 52%, Multifocal sub- epicardial and midmyocardial LGE Recovered and Discharged
Midsternal sharp chest pain, waxing/and po- sitional; relieved with leaning forward Not significant LVEF = 55% Cardiac troponin I ng/mL peak = 44.8, C-reactive protein peak, mg/dL = 0.1 Colchicine, ibuprofen, fa- motidine Left ventricular ejection fraction = 48%
Midmyocardial LGE; no pericardial effusion
T2 = Myocardial edema		 Recovered and Discharged
Midsternal chest pain with deep inspiration ST elevation in V2-5 LVEF = 50–55% Cardiac troponin I ng/mL peak = 8.36 ng/mL in patient 6 and cTnI 2601 ng/L in patient 7 Ibuprofen, famotidine Left ventricular ejection fraction = 50%,Multifocal patchy subepi- cardial and mid- myocardial LGE
T2 = Myocardialedema in patient 6 and basal midwall anteroseptal delayed enhancement in patient 7		 Recovered and Discharged
Fevers, diffuse myalgias, and headache starting day of vaccination; sudden onset of sharp chest pain the night before admission that persisted at 3 out of 10 intensity, worsened when lying flat Diffuse ST elevation LVEF = 58%, High sensitive Cardiac trop I 2601 ng/mL Beta blockers, colchicine Patchy mid subepicardial LGE Recovered and Discharged
31 Case report Singh et al., 2021 [40] Chest pain:left-sided, severe, constant, non-radiating, was associated with headache ST-depression in lead III LVEF = 55% Cardiac troponin I ng/mL peak = 8.36, C-reactive protein peak, mg/dL = 8.2 No specific treatment mentioned Left ventricular ejection fraction = 52%, Subepicardial LGE
T2 = inferior wall myocardial edema		 The patient was hospitalized for 4 days and discharged in a stable condition. He was seen in an outpatient clinic 6 weeks later, is doing well and is back at work.
32 Case report Sokolska et al., 2021 [20] Severe chest pain Q wave and ST-segment elevation in leads II, III and aVF LVEF = 58% high-sensitive troponin (6490–6559 pg/mL; reference range <34 pg/mL), C-reactive protein (82 mg/L; reference range <5 mg/L) Not mentioned Diffuse subepicardial LGE Recovered and Discharged
33 Case series Starekova et al., 2021 [25] Chills, headache, fever, chest discomfort and pain, dyspnea Diffuse ST-elevations LVEF = 32% troponin (6490–6559 pg/mL), C-reactive protein (82 mg/L). Not mentioned Linear, midmyocardial septum, epicardial LGE Follow-up not mentioned
Headache, body ache, fatigue, chest discomfort and pain Nonspecific T-wave abnormality LVEF = 64% Troponin-I at peak (ng/mL) = 3.82 Not mentioned Pericardial enhancement and small effusion. Epicardial LV LGE Follow-up not mentioned
Subjective Mild Fever, Chills, Malaise,Nausea, Chest pain diffuse ST elevations LVEF = 53% Troponin-I at peak (ng/mL) = 1.02BNP (pg/mL) = 75 Not mentioned LGE epicardial LV, Pericardial enhancement, no effusion. Follow-up not mentioned
Subjective Mild Fever, Chills, Malaise,Nausea, Chest pain Nonspecific T-wave abnormality LVEF = 57% Troponin-I at peak (ng/mL) = 14.65 Not mentioned Epicardial LV, Pericardial enhancement, no effusion. Epicardial LV LGE Follow-up not mentioned
Myalgias, Malaise, Nausea, lightheadedness, chest pain Inferolateral T-wave inversion LVEF = 54% Troponin-I at peak (ng/mL) = 4 Not mentioned LGE: epicardial LV. Pericardial enhancement and borderline effusion., Follow-up not mentioned
34 Case report Tailor et al., 2021 [47] Severe chest pain radiating to both arms, associated with acute dyspnea ST segment elevation in lateral limb and precordial leads LVEF = 40% with global hypokinesia mainly at apex Troponin-I at peak (ng/mL) = 12.19 Brief course of intravenous diuretics for mild symptoms of congestion. Angiotensin-converting enzyme inhibitor and a beta-blocker therapy were commenced to treat systolic dysfunction. He was also initiated on colchicine to treat mild persistent chest pain patchy linear mid-myocardial enhancement of the septum and inferior walls at the base to mid-ventricle, sub-epicardial/mid-myocardial enhancement of the lateral wall at the mid-ventricle and apical lateral wall He was discharged home after 5 days of monitoring without evidence of electrical or haemodynamic instability and with NYHA Class I symptoms
35 Case report Ujueta et al., 2021 [37] Progressive body aches, weakness and worsening fatigue Sinus tachycardia with T wave inversions in the septal leads with right atrial enlargement Biventricular cardiomyopathy with LVEF = 29%, and a small pericardial effusion C-reactive protein 63.5 <_8.0 mg/L
Peak troponin T, 847		 Vasopressin, Phenylephrine, and Epinephrine. Intravenous (IV) Methylprednisolone 60 mg bolus was administered every 8 h, Multiple immunohistochemistry staining like CD163 supports the diagnosis of lymphohistiocytic myocarditis with sparse eosinophils patient expired after several rounds of advanced cardiovascular life support. Consent was obtained for an autopsy.
36 Case series Verma et al., 2021 [41] Dyspnea and dizziness Tachycardia; STsegment depression Severe biventricular cardiomyopathy with LVEF = 29%, and a small pericardial effusion Cardiac Marker Troponin I 6.4 ng/mL peak, C-Reactive protein = 49 Vaso-pressin, Phenylephrine, and Epinephrine. Intravenous (IV) Methyl-prednisolone CMR Not mentioned, endomyocardial biopsy confirmed the diagnosis Recovered and Discharged
Dyspnea and chest pain Diffuse ST-segment elevation LVEF = 15% Troponin I level of 6.14 ng per milliliter Inotropic support, intravenous diuretics, methylprednisolone and guidelinedirected medical therapy for heart failure (lisinopril, spironolactone, and metoprolol succinate) Histologically confirmed during autopsy Patient expired
37 Case report Williams et al., 2021 [50] Fevers and myalgias and dull, retrosternal chest pain Lateral PR depression and ST elevation mirrored in aVR with PR elevation and ST depression LVEF = 43% Troponin T 1.30 ng/mL; CRP 10.2 mg/dL Ibuprofen Slightly reduced left ventricular pump function, myocardial edema, and subepicardial late gadolinium enhancement Recovered and Discharged
38 Case series Levin et al.(2021) [24] Fatigue, headache, abdominal pain, chest pain radiating to right arm, perspiration ST elevation LVEF = 43% Troponin T (hs-cTnT) concentration of 4026 ng/L, and C-reactive protein 111 mg/L High dose aspirin, colchicine, bisoprolol and rampiril LVEF to 54% with subepicardial late gadolinium enhancement, patchy myocardial edema, pericardial enhancement Recovered and Discharged
Abdominal pain, chest and fatigue ST elevation, inferiorleads, reciprocal depression on leads I and AVL. LVEF = 45% Troponin-I − 22,000 ng/L (0–50),CRP- 58.54 mg/L (<0.03–5) Bisoprol. Ramipril Cardiac spectral CT-sub epicardial focal enhancement of the lateral wall and septum of the inferior wall, Nopericardial or pleural effusion Recovered and Discharged
Fatigue, throat pain and dizziness Normal ECG LVEF = 60% Troponin-I15,000 ng/dL (0–50), CRP9 mg/L (<0.03–5) Bisoprol, Ramipril Cardiac CT- late adherence through the lateral wall, the inferior basal wall, the apex and middle part of theseptum Recovered and Discharged
Chest pain radiating to the left arm, fatigue ST-elevation I, II, III,AVF, V3-6 leads LVEF = 60% Troponin-I15,527 ng/dL (0–50),CRP- 44 mg/L (<0.03–5) Bisoprol, Ramipril Cardiac MRI(two weeks after discharge) -LV EF51%, and late subepicardial and mesocardiac enhancement of 5% of LV wall Recovered and discharged
Squeezing chest pain and dyspnea Diffuse ST-segment elevation in septal and lateral leads, and PR segment depressions in inferior leads. Normal Troponin-I6000 ng/Dl, CRP7 mg/L (0.2–5) Colchicine, Ibuprofen Not mentioned Recovered and Discharged
Fever and malaise, squeezing chest pain radiating to the back Sinus tachycardia and findings consistent with LV hypertrophy. LVEF = 60% Troponin-T409 ng, CRP = 58.1 mg/L (0.2–5) Colchicine, Ibuprofen Myocardial edema and LGE were noted in the basal LV and subepicardial myocardium Recovered and Discharged
Stabbing chest pain aggravated by lying down, myalgia, headache, malaise Diffuse ST-segment elevation associated with ST-segment depression in AVR and PR segment depression. Normal Troponin-T – 33 ng/L (0–14), CRP − 4 mg/L Colchicine Not mentioned Recovered and Discharged
39 Case report Patrignani et al. (2021) [22] Stabbing chest pain aggravated by lying down, myalgia, headache, malaise Diffuse ST-segment elevation associated with ST-segment depression in AVR and PR segmentedession LVEF = 38–40% Troponin-T-2300 ng/L (0–20), CRP = 120 mg/L (0–5). Colchicine, Bisoprol LGE in subepicardial and midmyocardium along the lateral wall, infero-basalwall and mid- and basal septum involving 8% of myocardial mass. Recovered and Discharged
40 Case report Sulemankhil et al.(2021) [49] Acute substernal chest pain followed by constant, retrosternal, non-radiating, non-exertional chest pain. Normal ECG Normal Troponin T 0.041 ng/mL (Normal range <0.014 ng/mL), CRP = 40.4 mg/L Not mentioned A gadolinium-enhanced cardiac magnetic resonance imaging showed a small focal area of myocarditis in the mid to apical lateral region of the left ventricle with a scar size of 2% Recovered and Discharged
41 Case report Garcia et al. (2021) [13] Fever. Intermittent chest and interscapular pain Diffuse ST-segment elevation NOT significant Troponin T (hsTnT) of 139 ng/L. Anti-inflammatory treatment Subepicardial edema Follow-up not mentioned
LGE: Late Gadolinium Enhancement LVEF: Left Ventricular Ejection Fraction, EF: Ejection Fraction, CRP: C-Reactive Protein, TTE: transthoracic Echocardiogram, CMR: Cardiac Magnetic Resonance Imaging, ECG: Electrocardiogram, LV: Left Ventricle.
Original Article:
Sr No Study Design Author, Year Country reported Sample size Age Gender (M/F) Follow-up Comparator Experimental group characteristics (Vaccine administered) Outcome Results
Clinical features
1 Retrospective observational study George A. Diaz, 2021 [54] USA 2000287 median = 57(40–70) 822118/1178169 N/A None BNT162b2(Pfizer/BionTech) = 52.6%, mRNA-1273(Moderna) = 44.1%, Ad26.COV2.S(Janssen/Johnson & Johnson) = 3.1%, 76.1% received more than 1 dose Myocarditis = 20, pericarditis = 37 where 4 participants developed myocarditis after first dose and 16 developed after second dose, 15 participants developed pericarditis after first dose and 22 developed after second dose Mild Myocarditis = 20 (100%) Rate Ratio: myocarditis: (1.0 [95% CI, 0.61–1.54] per 100,000), Pericarditis:(1.8 [95% CI, 1.30–2.55] per 100,000)
Mild Pericarditis = 37 (100%)
ECG changes = 23 (40%)
Abnormal EF = 8 (14%)
Elevated Troponin = 9 (16%)
2 Prospective cohort study Han. W. Kim, 2021 [56] USA 4 Mean:38.5 3/1 N/A None BNT162b2(Pfizer/BionTech) = 2, Moderna (mRNA1273) = 2, Dose = 2, Onset of symptoms = 3 days after vaccination for patient 1,5 days after vaccination for patient 2, 1 day after vaccination for patient 3, 2 days after vaccination for patient 4 Myocarditis in all four patients Mild myocarditis = 4 (100%) N/A
Chest pain = 4 (100%)
Dyspnea = 3 (75%)
Fever = 3 (75%)
ECG changes = 4 (100%)
ST-segment elevation = 4 (100%)
Elevated Troponin = 4 (100%)
C-reactive protein = 3 (75%)
LGE = 4 (100%)
LVEF (abnormal) = 1 (25%)
3 Retrospective cohort study Guy Witberg, 2021 [57] Israel 2,558,421 median44 [[30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63]] 1,248,433/1,309,988 42 days None BNT162b2(Pfizer/BionTech) = 2,558,421, All of the participants received first dose. whereas 2,401,605 participants received second dose. Myocarditis = 54 Mild myocarditis = 41(76%) Intermediate myocarditis = 12 (22%). LVD = 14(26%) Cumultative incidence: 2.13(1.56–2.70)per 1,00,000
chest pain = 44 (81%)
Dyspnea = 3 (5.5%)
Fever = 5 (9%)
Pericardial effusion = 10 (18.5%)
ECG changes = 38 (70%)
Elevated Troponin T = 41
4 Retrospective cohort study Noam Barda, 2021 [53] USA 1,736,832 median age 38 903153/833679 42 days Unvaccinated = 884828 Vaccinated group,BNT162b2(Pfizer/BionTech):884,828 In vaccinated group: Myocarditis:21 Pericarditis:27 In non-vaccinated group: Myocarditis: 6, pericarditis: 18 N/A Risk Ratio: Myocarditis: 3.24 (1.55–12.44), Pericarditis:1.27 (0.68–2.31)
5 Retrospective cohort study Mevorach et al., 2021 [55] Israel 9,289,765 – 2,668,894/2,773,802 183 days None BNT162b2(Pfizer/BionTech) = 5,442,696. 1st dose: 5,442,696, 2nd Dose: 5,125,635 Myocarditis: 136, After first dose:19 After second dose: 117 Mild myocarditis: 129 (90.9%) cases. RD (95%CI) for myocarditis according to age and sex (21 days after first dose): 3.19 (2.37–4.02) Standardized Incidence ratio for myocarditis according to age, sex and dose: 5.34
(4.48–6.40), Rate ratio of myocarditis within 30 days after second dose as compared to unvaccinated patients: 2.35 (1.10–5.02)
Chest pain = 129 (95%)
Fever = 63 (46.7%)
Dyspnea = 17 (12.5%)
ECG changes = 93 (68%)
Elevated Troponin I or T = 136 (100%)
Elevated C-reactive protein = 118 (86.7%)
LGE = 48 (35%)

LVEF = Left Ventricular Ejection Fraction, EF = Ejection Fraction, LGE = Late Gadolinium enhancement, LVD = Left Ventricular Dysfunction, ECG = Electrocardiogram, RD = Risk difference.