RESUMEN
The benefits of vaccination - regarding COVID-19 infection and transmission, as well as COVID-associated complications - clearly outweigh the potential risk of vaccine-associated inflammation of the heart and other adverse events. Given the current state of knowledge, the outcome of myocarditis and pericarditis following vaccination is generally good. This review aims to guide physicians in the early diagnosis and management of suspected myocarditis following mRNA COVID vaccination. The initial work-up should include detailed history, a 12-lead electrocardiogram and serological biomarkers (high-sensitivity cardiac troponin T/I, natriuretic peptides and markers of inflammation) in accordance with the assessments recommended in current clinical practice guidelines for patients presenting with acute chest pain. In patients with suspected myocarditis, further assessment with transthoracic echocardiography and cardiovascular magnetic resonance imaging should be undertaken to confirm peri-/myocarditis and to distinguish the findings from other diseases with similar presentation. Patients with mRNA vaccine-associated myocarditis should be followed-up at least once to exclude chronic myocardial inflammation and deterioration of left ventricular ejection fraction. Consultation with an expert such as an immunologist with experience in vaccination regarding further mRNA vaccinations is advised in all patients with mRNA vaccine-associated perimyocarditis. Reporting of mRNA vaccine-associated myocarditis to Swissmedic is mandatory. Cohort studies prospectively follow-up on young adult and paediatric populations following immunisation with an mRNA COVID vaccine to monitor cardiac and immune parameters would generate valuable knowledge to better understand pathogenesis and risk factors for vaccine-associated perimyocarditis.
Asunto(s)
COVID-19 , Miocarditis , Pericarditis , Vacunas contra la COVID-19 , Niño , Humanos , Pericarditis/etiología , ARN Mensajero , SARS-CoV-2 , Volumen Sistólico , Vacunación/efectos adversos , Función Ventricular Izquierda , Adulto JovenAsunto(s)
Válvula Aórtica/cirugía , Aspergilosis/terapia , Aspergillus niger/aislamiento & purificación , Remoción de Dispositivos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Saccharomyces cerevisiae/aislamiento & purificación , Adulto , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Aspergillus niger/efectos de los fármacos , Pan/microbiología , Cocaína/administración & dosificación , Contaminación de Medicamentos , Femenino , Harina/microbiología , Humanos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Saccharomyces cerevisiae/efectos de los fármacos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Resultado del TratamientoRESUMEN
A 64-year-old man presented with severe myocarditis 6 weeks after an initial almost asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection. He was found to have a persistent positive swab. Mechanisms explaining myocardial injury in patients with COVID-19 remains unclear, but this case suggests that severe acute myocarditis can develop in the late phase of COVID-19 infection, even after a symptom-free interval.