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2.
J Cardiovasc Med (Hagerstown) ; 23(7): 447-453, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1910939

ABSTRACT

BACKGROUND: Myocarditis and pericarditis have been proposed to account for a proportion of cardiac injury during SARS-CoV-2 infection. The impact of COVID-19 the pandemic on the incidence of this acute inflammatory cardiac disease was not systematically evaluated. AIM: To examine the incidence and prevalence of inflammatory heart disorders prior to and during the COVID-19 pandemic. METHODS: We compared the incidence and prevalence of acute inflammatory heart diseases (myocarditis, pericarditis) in the provinces of Pisa, Lucca and Livorno in two time intervals: prior to (PRECOVID, from 1 June 2018 to 31 May 2019) and during the COVID-19 pandemic (COVID, from 1 June 2020 to May 2021). RESULTS: Overall 259 cases of inflammatory heart disease (myocarditis and/or pericarditis) occurred in the areas of interest. The annual incidence was of 11.3 cases per 100 000 inhabitants. Particularly, 138 cases occurred in the pre-COVID, and 121 in the COVID period. The annual incidence of inflammatory heart disease was not significantly different (12.1/100 000 in PRECOVID vs 10.3/100 000 in COVID, P = 0.22). The annual incidence of myocarditis was significantly higher in PRECOVID than in COVID, respectively 8.1/100 000/year vs. 5.9/100 000/year (P = 0.047) consisting of a net reduction of 27% of cases. Particularly the incidence of myocarditis was significantly lower in COVID than in PRECOVID in the class of age 18-24 years. Despite this, myocarditis of the COVID period had more wall motion abnormalities and greater LGE extent. The annual incidence of pericarditis was, instead, not significantly different (4.03/100 000 vs, 4.47/100 000, P = 0.61). CONCLUSION: Despite a possible etiologic role of SARS-CoV-2 and an expectable increased incidence of myocarditis and pericarditis, data of this preliminary study, with a geographically limited sample size, suggest a decrease in acute myocarditis and a stable incidence of pericarditis and of myopericarditis/perimyocarditis.


Subject(s)
COVID-19 , Myocarditis , Pericarditis , Acute Disease , Adolescent , Adult , COVID-19/epidemiology , Humans , Incidence , Myocarditis/complications , Pandemics , Pericarditis/epidemiology , Pericarditis/etiology , SARS-CoV-2 , Young Adult
3.
Nat Commun ; 13(1): 3633, 2022 06 25.
Article in English | MEDLINE | ID: covidwho-1908177

ABSTRACT

Cases of myocarditis and pericarditis have been reported following the receipt of Covid-19 mRNA vaccines. As vaccination campaigns are still to be extended, we aimed to provide a comprehensive assessment of the association, by vaccine and across sex and age groups. Using nationwide hospital discharge and vaccine data, we analysed all 1612 cases of myocarditis and 1613 cases of pericarditis that occurred in France in the period from May 12, 2021 to October 31, 2021. We perform matched case-control studies and find increased risks of myocarditis and pericarditis during the first week following vaccination, and particularly after the second dose, with adjusted odds ratios of myocarditis of 8.1 (95% confidence interval [CI], 6.7 to 9.9) for the BNT162b2 and 30 (95% CI, 21 to 43) for the mRNA-1273 vaccine. The largest associations are observed for myocarditis following mRNA-1273 vaccination in persons aged 18 to 24 years. Estimates of excess cases attributable to vaccination also reveal a substantial burden of both myocarditis and pericarditis across other age groups and in both males and females.


Subject(s)
COVID-19 , Myocarditis , Pericarditis , 2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Incidence , Male , Myocarditis/complications , Pericarditis/epidemiology , Pericarditis/etiology , RNA, Messenger , Vaccination/adverse effects , mRNA Vaccines
4.
Curr Opin Cardiol ; 37(4): 335-342, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1901275

ABSTRACT

PURPOSE OF REVIEW: There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS: Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY: Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.


Subject(s)
COVID-19 , Cardiologists , Myocarditis , Arrhythmias, Cardiac/etiology , COVID-19/complications , COVID-19 Vaccines , Humans , Myocarditis/complications , Myocarditis/etiology , SARS-CoV-2
5.
Respir Med Res ; 81: 100904, 2022 May.
Article in English | MEDLINE | ID: covidwho-1900123

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.


Subject(s)
COVID-19 , Myocarditis , COVID-19/complications , COVID-19 Vaccines , Humans , Myocarditis/complications , Myocarditis/etiology , Pandemics , SARS-CoV-2
6.
Eur J Heart Fail ; 24(7): 1319-1322, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1898655

ABSTRACT

Herein we report the case of a young man, admitted to the Department of Cardiology and Angiology at Hannover Medical School with shortness of breath and elevated troponin. Few weeks earlier the patient received the first dose of BioNTech's mRNA vaccine (Comirnaty, BNT162b2). After diagnostic work-up revealed giant cell myocarditis, the patient received immunosuppressive therapy. In the present context of myocarditis after mRNA vaccination we discuss this rare aetiology and the patient's treatment strategy in the light of current recommendations.


Subject(s)
BNT162 Vaccine , COVID-19 , Myocarditis , BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Giant Cells , Humans , Male , Myocarditis/complications , Myocarditis/etiology , Vaccination/adverse effects
7.
G Ital Cardiol (Rome) ; 23(6): 408-413, 2022 Jun.
Article in Italian | MEDLINE | ID: covidwho-1892438

ABSTRACT

Vaccine-associated myocarditis and pericarditis usually develop within 14 days of COVID-19 vaccination, are exceptionally rare, manifest with mild clinical pictures and are commonly characterized by a favorable evolution. Young men inoculated with two doses of an mRNA vaccine are the subgroup at higher risk. Recent epidemiological studies evaluated the incidence and risk of vaccine-associated myocarditis and pericarditis among men and women, in different ranges of age and specific types of vaccines. Long-term population analyses demonstrated that the cardiovascular risk conferred by COVID-19 extends beyond the acute phase, representing the rationale for implementing prevention strategies for SARS-CoV-2 infection, monitoring specific populations at higher risk and pursuing the completion of the vaccination campaign. This document provides an update on the most recent scientific evidence and critical interpretation of available data in constant evolution towards personalized strategies of immunization.


Subject(s)
COVID-19 , Cardiology , Myocarditis , Pericarditis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Expert Testimony , Female , Humans , Italy/epidemiology , Male , Myocarditis/complications , Pericarditis/etiology , SARS-CoV-2 , Vaccination , Vaccines, Synthetic
8.
Scand Cardiovasc J ; 56(1): 166-173, 2022 12.
Article in English | MEDLINE | ID: covidwho-1882917

ABSTRACT

Objective. Patients with underlying heart diseases have a higher risk of dying from Covid-19. It has also been suggested that Covid-19 affects the heart through myocarditis. Despite the rapidly growing research on the management of Covid-19 associated complications, most of the ongoing research is focused on the respiratory complications of Covid-19, and little is known about the prevalence of myocarditis. Design. This study aimed to characterize myocardial involvement by using a panel of antibodies to detect hypoxic and inflammatory changes and the presence of SARS-CoV-2 proteins in heart tissues obtained during the autopsy procedure of Covid-19 deceased patients. Thirty-seven fatal COVID-19 cases and 21 controls were included in this study. Results. Overall, the Covid-19 hearts had several histopathological changes like the waviness of myocytes, fibrosis, contract band necrosis, infiltration of polymorphonuclear neutrophils, vacuolization, and necrosis of myocytes. In addition, endothelial damage and activation were detected in heart tissue. However, viral replication was not detected using RNA in situ hybridization. Also, lymphocyte infiltration, as a hallmark of myocarditis, was not seen in this study. Conclusion. No histological sign of myocarditis was detected in any of our cases; our findings are thus most congruent with the hypothesis of the presence of a circulating endothelium activating factor such as VEGF, originating outside of the heart, probably from the hypoxic part of the Covid-19 lungs.


Subject(s)
COVID-19 , Myocarditis , Heart , Humans , Myocarditis/complications , Myocarditis/pathology , Necrosis/complications , SARS-CoV-2
9.
J Korean Med Sci ; 37(21): e169, 2022 May 30.
Article in English | MEDLINE | ID: covidwho-1875392

ABSTRACT

With the global spread of severe acute respiratory syndrome coronavirus 2, several vaccines were developed; messenger RNA (mRNA) vaccines have recently been widely used worldwide. However, the incidence of myocarditis following mRNA vaccination is increasing; although the cause of myocarditis has not yet been clearly identified, it is presumed to be caused by a problem in the innate immune system. Immune-mediated thrombocytopenia (ITP) after vaccination is rare but has been reported and is also assumed to occur by the same mechanism. We report the first case of simultaneous myocarditis and ITP after mRNA vaccination. A 38-year-old woman presented with chest pain, mild dyspnea, and sweating after vaccination with mRNA-1273 vaccine (Moderna) 4 days prior to admission. Upon admission to the emergency department, cardiac enzymes were elevated; blood test performed 5 months ago showed normal platelet count, but severe thrombocytopenia was observed upon admission. After administration of intravenous immunoglobulin, the platelet count improved; subsequently, myocarditis was observed on endomyocardial biopsy. Thus, myocarditis and ITP were judged to have occurred simultaneously due to the expression of the innate immune system markers after mRNA vaccination. The patient was discharged on day 6 of admission.


Subject(s)
COVID-19 , Myocarditis , Purpura, Thrombocytopenic, Idiopathic , Thrombocytopenia , Vaccines , 2019-nCoV Vaccine mRNA-1273 , Adult , COVID-19 Vaccines/adverse effects , Female , Humans , Myocarditis/complications , Myocarditis/etiology , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/etiology , RNA, Messenger/genetics , Thrombocytopenia/complications , Thrombocytopenia/etiology , Vaccination/adverse effects
10.
Intern Med ; 61(15): 2319-2325, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1869294

ABSTRACT

A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium.


Subject(s)
COVID-19 , Coronavirus , Heart-Assist Devices , Myocarditis , BNT162 Vaccine , COVID-19/complications , Female , Heart-Assist Devices/adverse effects , Humans , Middle Aged , Myocarditis/complications , RNA/therapeutic use , Shock, Cardiogenic/etiology , Spike Glycoprotein, Coronavirus , Vaccination/adverse effects
12.
Int J Environ Res Public Health ; 19(10)2022 05 12.
Article in English | MEDLINE | ID: covidwho-1855596

ABSTRACT

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.


Subject(s)
COVID-19 , Myocarditis , Adult , COVID-19/diagnostic imaging , Cicatrix/complications , Cicatrix/diagnostic imaging , Echocardiography/methods , Female , Humans , Male , Middle Aged , Myocarditis/complications , Myocarditis/diagnostic imaging , Prognosis , RNA, Viral , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
13.
Curr Neurol Neurosci Rep ; 22(7): 363-374, 2022 07.
Article in English | MEDLINE | ID: covidwho-1850422

ABSTRACT

PURPOSE OF REVIEW: The present review discusses the neurological complications associated with myocarditis of different etiologies. RECENT FINDINGS: Myocarditis can be idiopathic or caused by different conditions, including toxins, infections, or inflammatory diseases. Clinical findings are variable and range from mild self-limited shortness of breath or chest pain to hemodynamic instability which may result in cardiogenic shock and death. Several neurologic manifestations can be seen in association with myocarditis. Tissue remodeling, fibrosis, and myocyte dysfunction can result in heart failure and arrhythmias leading to intracardiac thrombus formation and cardioembolism. In addition, peripheral neuropathies, status epilepticus, or myasthenia gravis have been reported in association with specific types of myocarditis. Multiple studies suggest the increasing risk of neurologic complications in patients with myocarditis. Neurologists should maintain a high suspicion of myocarditis in cases presenting with both cardiovascular and neurological dysfunction without a clear etiology.


Subject(s)
Myocarditis , Peripheral Nervous System Diseases , Humans , Myocarditis/complications , Myocarditis/diagnosis
14.
Ann Glob Health ; 88(1): 18, 2022.
Article in English | MEDLINE | ID: covidwho-1818561

ABSTRACT

Background: COVID-19 myocarditis is becoming increasingly appreciated as a complication of COVID-19. There are significant hurdles to formal diagnosis with endomyocardial biopsy or cardiac MRI, whether by resource limitations, patient instability, or isolation precautions. Therefore, further exploratory analysis is needed to clinically define the characteristics and spectrum of severity of COVID-19 myocarditis. Objectives: The aim of this study was to describe the clinical course, echocardiographic, and laboratory testing across suspected fulminant and non-fulminant clinically defined COVID-19 myocarditis. Methods: In a cross-sectional observational study of 19 patients with clinically defined COVID-19 myocarditis, we report presenting symptoms, clinical course, laboratory findings, and echocardiographic results stratified by non-fulminant and fulminant myocarditis. Student t-test and univariate logistic regression are used to compare laboratory findings across fulminant and non-fulminant cases. Findings: Among 19 patients, there was no prior history of coronary artery disease, atrial fibrillation, or heart failure; 21.1% of patients died; and 78.9% of cases required supplemental oxygen. A significantly higher geometric mean D-dimer and ferritin were observed in patients with fulminant compared to non-fulminant suspected myocarditis. 26.3% of cases had pericardial effusions. 10 out of the 16 with available echocardiographic data had normal left ventricular systolic function. Conclusions: In this study, we provide a practical clinical depiction of patients with clinical COVID-19 myocarditis across fulminant and non-fulminant cases. Statistically significant elevations in inflammatory markers in fulminant versus non-fulminant cases generate hypotheses regarding the role of systemic inflammation. While cardiac MRI and endomyocardial biopsy may not be accessible at scale in low- and middle-income countries, the present study offers a clinical definition of COVID-19 myocarditis and accessible laboratory findings to define severity.


Subject(s)
COVID-19 , Myocarditis , Cross-Sectional Studies , Echocardiography , Humans , Myocarditis/complications , Myocarditis/diagnostic imaging , New York City/epidemiology
15.
J Investig Med High Impact Case Rep ; 10: 23247096221092291, 2022.
Article in English | MEDLINE | ID: covidwho-1808263

ABSTRACT

Viral infections are a common cause of acute myocarditis. However, vaccines including influenza and smallpox have also been rarely implicated. Recently, the coronavirus disease 2019 (COVID-19) vaccines have been associated with acute myocarditis. We describe a case of acute myocarditis in a 19-year-old male 2 days after the initial dose of the COVID-19 mRNA-1273 vaccine. He presented with chest pain radiating to his left arm and bilateral shoulders. COVID, influenza, coxsackie, respiratory syncytial virus polymerase chain reaction (PCR) tests were negative. Electrocardiogram revealed diffuse ST-segment elevation. Initial Troponin was 15.7 ng/mL. A coronary angiogram revealed patent coronary arteries and no wall motion abnormality. A transthoracic echocardiogram showed diffuse hypokinesis with an ejection fraction of 49%. Cardiac magnetic resonance scan was aborted after 2 attempts due to severe claustrophobia. His chest pain resolved following initiation of aspirin, tylenol, colchicine, lisinopril, and metoprolol.


Subject(s)
COVID-19 , Influenza, Human , Myocarditis , 2019-nCoV Vaccine mRNA-1273 , Adult , COVID-19 Vaccines/adverse effects , Chest Pain/etiology , Humans , Influenza, Human/complications , Male , Myocarditis/complications , Vaccination/adverse effects , Young Adult
17.
Int J Cardiol ; 358: 136-139, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1796722

ABSTRACT

BACKGROUND: Complications following COVID-19 vaccination, particularly with mRNA vaccines, rarely include myocarditis and pericarditis. This work principally aimed at defining a realistic temporal relationship between vaccination and myocarditis/pericarditis development. METHODS: All relevant cases reported from week 52/2020 through week 41/2021 in the VAERS database were retrieved and analyzed for licensed vaccines. These included BNT162b2, mRNA-1273, and AD26.COV2·S. Incidence rates were calculated using the corresponding administered vaccine doses as denominators. Additionally, analyzed parameters included demographics, dose series, hospitalization length and outcome. RESULTS: Overall, 2016 myocarditis and 1380 pericarditis cases, (4.96/106 and 3.40/106 administered vaccine doses, respectively), were recorded. Most myocarditis cases occurred following BNT162b2 (5.60/106 doses) in males <30 years. Pericarditis affected predominantly males <40, both sexes >40 years, and was most common post AD26.COV2·S (4.78/106 doses). Hospitalization was required for 40.3% and 27.2% of myocarditis and pericarditis cases, respectively. A bimodal pattern was found for both myocarditis and pericarditis, with two peaks that coincided temporally, but were reversed in intensity. The first peak was recorded 1-3 days post-vaccination and was more pronounced in myocarditis, while the second was recorded 15-30 days post-vaccination and was more intense in pericarditis. CONCLUSIONS: Myocarditis/pericarditis after COVID-19 vaccination is rare and depicts a bimodal pattern.


Subject(s)
COVID-19 , Myocarditis , Pericarditis , Ad26COVS1 , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Male , Myocarditis/complications , Myocarditis/etiology , Pericarditis/diagnosis , Pericarditis/epidemiology , Pericarditis/etiology , SARS-CoV-2 , Vaccination/adverse effects
19.
J Korean Med Sci ; 37(13): e104, 2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1775638

ABSTRACT

Vaccines have become the mainstay of management against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019; COVID-19) in the absence of effective antiviral therapy. Various adverse effects of COVID-19 vaccination have been reported, including cardiovascular complications such as myocarditis or pericarditis. Herein, we describe clinical records of a 63-year woman with fulminant myocarditis following ChAdOx1 nCoV-19 vaccination that was salvaged by heart transplantation. She complained chest pain, nausea, vomiting, and fever after the second vaccination. After the heart transplantation, the patient died due to necrotizing pneumonia on the 54th day of onset. Fulminant myocarditis is very rare after ChAdOx1 nCoV-19 vaccination but can be fatal.


Subject(s)
COVID-19 , Heart Transplantation , Myocarditis , COVID-19 Vaccines/adverse effects , Female , Heart Transplantation/adverse effects , Humans , Myocarditis/complications , Myocarditis/etiology , SARS-CoV-2 , Vaccination/adverse effects
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