Table 1.
Patient demographic and medicals characteristics and associated health outcomes.
| Case 1 | Case 2 | Case 3 | Case 4 | ||
|---|---|---|---|---|---|
| Definition | Confirmed | Confirmed | Confirmed | Confirmed | |
| Age, y | 19 | 20 | 29 | 48 | |
| Sex | Male | Male | Male | Male | |
| Race/ethnicity | Caucasian | Again | Again | Again | |
| Vaccine type | |||||
| Types of mRNA vaccines | mRNA-1273-Moderna | mRNA-1273-Moderna | mRNA-1273-Moderna | BNT162b2 mRNA-Pfizer-BioNTech | |
| Number of vaccinations | 2 | 2 | 2 | 1 | |
| History of previous COVID-19 infection | Denied/ negative antigen | Denied/ negative antigen | Denied/ negative PCR | Denied/ negative PCR | |
| Symptoms | |||||
| Day 1 post-vaccination | Chest discomfort | Fever | Fever | No symptom | |
| Day 2 post-vaccination | Chest pain, pain with breathing, hospital admission | Chest pressure, nausea | Chest pain, hospital admission | Fever, tiredness, diarrhea | |
| Day 3 post-vaccination | Hospital admission | Tiredness | |||
| Day 4 post-vaccination | Tiredness | ||||
| Day 5 post-vaccination | Syncope, tiredness, hospital admission | ||||
| Vital signs at presentation | |||||
| Temperature, °C | 36.9 | 39.1 | 36.2 | 35.4 | |
| Heart rate, bpm | 100 | 106 | 73 | 80 | |
| Blood pressure, mm Hg | 109/58 | 120/57 | 117/69 | 85/57 | |
| Respirations, per min | 18 | 20 | 18 | 20 | |
| Chest x-ray findings | No acute pulmonary disease | No acute pulmonary disease | No acute pulmonary disease | enlarged cardiac shadow | |
| Cardiothoracic ratio (CTR) | 48.4% | 48.4% | 43.4% | 54.5% | |
| ECG findings | |||||
| ST changes | No | ST elevation in V3–6 | No | Negative T wave in V4–6 | |
| Rhythm | Normal sinus rhythm | Normal sinus rhythm | Normal sinus rhythm | Paroxysmal atrioventricular block | |
| Echocardiogram | |||||
| Number of days after vaccination | 3 days | 5 days | 3 days | 5 days | |
| LV ejection fraction | 52 | 62 | 58 | 30 | |
| LV end-diastolic internal dimension | 48 | 51 | 40 | 47 | |
| LV end-systolic internal dimension | 35 | 36 | 28 | 36 | |
| Intraventricular septal diastolic thickness | 9 | 10 | 9 | 14 | |
| LV posterior wall thickness | 12 | 10 | 12 | 15 | |
| E/A | 2.09 | 1.7 | 1.13 | 0.63 | |
| E/e' | 3.68 | 7.15 | 4.65 | 9.02 | |
| Regional wall motion abnor- malities | None | None | Non | Diffuse hypokinesis | |
| Diastolic function | Normal | Normal | Normal | ||
| Cardiac magnetic resonance imaging (cMRI) | |||||
| Number of days between last vaccination and cMRI | 5 days | 6 days (first time) | 45 days (second time) | 12 days | 12 days |
| LGE | Sub-epicardial wall of basal-mid infero-lateral LV | Na | mid wall of basal inferior LV | mid wall of anterior, and inferior LV | Mid-wall of basal inferior, Sub-epicardial wall of mid- and infero-septum LV |
| Definition | Confirmed | Confirmed | Confirmed | Confirmed | |
| T2WBB high signal | Sub-epicardial wall of basal-mid infero-lateral LV | mid wall of basal inferior LV | Na | mid wall of anterior, and inferior LV | Mid-wall of basal inferior, Sub-epicardial wall of mid- and infero-septum LV |
| Laboratory findings | |||||
| Cardiac troponin I pg/mL | |||||
| Presentation | 1,801.7 | 1,885.6 | 4,419.6 | 17,888.7 | |
| Peak | 5,321.9 | 5,749 | 4,419.6 | 17,888.7 | |
| Postdischarge | <10 | <10 | <10 | 15.5 | |
| CK U/L peak | 415 | 324 | 154 | 765 | |
| CK-MB U/L peak | 30.8 | 15.3 | 9 | 64 | |
| WBC | 6,500 | 5,900 | 6,100 | 5,000 | |
| BNP, pg/mL | 9.1 | 12.1 | 9 | 111 | |
| CRP, mg/dL | 5.63 | 8.78 | 1.16 | 11.32 | |
| Coronary angiography findings | ND | MRI negative | CCT negative | CAG no stenosis | |
| Clinical course | |||||
| Hospitalization duration | 5 | 8 | 5 | 11 | |
| Treatment(s) | Ibuprofen, ACE-I | Ibuprofen, ACE-I | Ibuprofen, ACE-I | dobutamine, Diuretic, Ibuprofen, ACE-I | |
BNP, B-type natriuretic peptide; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; E/A, transmitral Doppler early (E-wave) to late (A-wave) ventricular filling velocities; E/e', E-wave to tissue Doppler early diastolic mitral annular velocity; LGE, late gadolinium enhancement; LV, left ventricular; T2WBB, T2 Weighed black blood; WBC, white blood cell.