HIGHLIGHTING THE RISE OF VACCINE-ASSOCIATED MYOCARDITIS AND WHAT IT MEANS FOR THE FUTURE OF MRNA VACCINES

ABSTRACT

Background: Vaccine-associated Myocarditis (VAM) is increasingly documented as a complication of COVID-19 mRNA vaccines. In the United States, as of 10/16/2021 188.9 million are fully vaccinated with mRNA vaccines. VAM has an incidence of 4.8 cases per million post 2nd dose of mRNA vaccines. We present a case of mRNA VAM in a young male and challenges faced in screening and management of this rare condition in a time where clearer guidelines are needed. Case 45 y/o male with no PMH presented with acute onset sharp midsternal chest pain associated with dyspnea and diaphoresis. Patient received the 2nd dose of the Moderna vaccine three days prior. Initial EKG ST-elevations in leads V2-V4;troponin 4.37 (peaked at 7.3);CRP 25.8. Coreg was initiated. Emergent cardiac catheterization nonobstructive CAD, mildly reduced systolic function 50%. Subsequent echo EF 40% with mild hypokinesis in apical segments. Colchicine was started. Symptoms resolved and patient was discharged with avoidance of strenuous activity. 1st follow-up improved symptomatology. Lisinopril was added. Repeat echo EF 60%. 2nd follow-up 2 weeks later he had presyncope. Holter no arrhythmia. Cardiac MRI multifocal mid-myocardial and subepicardial late gadolinium enhancement in apical and basal segments consistent with myocarditis. After 2 months, the patient was asymptomatic and exercise tolerant. Decision-making New data from the CDC, and the Israeli National Database indicate a causal relationship between the new mRNA vaccines and the increase in VAM. This complication predominantly affects young males like this patient within 7 days post 2nd dose. In this age group, observed numbers of VAM were > 10 times more than expected. This data incited a high index of suspicion which led to the diagnosis. Conclusion: Since this vaccine technology will likely monopolize future vaccine production, this condition is expected to increase in prevalence and the medical community needs to remain vigilant. Better guidance is needed on how best to screen and manage. Further research is thus warranted. We maintain that mRNA vaccines provide benefits which far outweigh this often self-limited complication.