A TOUCH OF THE HEART AND THE TOOLS FOR DIAGNOSIS

ABSTRACT

SESSION TITLE Infections In and Around the Heart Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: Myocarditis is inflammation of the heart muscle, and its onset is usually followed by an inciting event such as a viral infection. Here, we report a case of myocarditis in an adolescent male with no significant medical history who presented with chest pain after his second dose of the covid vaccine. CASE PRESENTATION An 18-year old male presented with no significant past medical/surgical history presented with chest pain. His only triggering event was receiving the second dose of his covid vaccine. A physical examination, chest x-ray, electrocardiogram, and echocardiogram revealed no significant findings. His laboratory findings were positive for myocardial damage with elevated troponin. All other laboratories for autoimmune and inflammation were negative. He was transferred to another facility for cardiac MRI, which subsequently had findings consistent with myocarditis. He remained asymptomatic, and laboratories were normalized. He was discharged and, on follow-up, remained asymptomatic. DISCUSSION: Covid vaccine-induced myocarditis has become a prominent issue. As of March 2022, there are 2323 preliminary reports of myocarditis/pericarditis following either mRNA vaccine, with most cases being young male adolescents. Prior vaccination, such as the smallpox vaccine, has a well-documented history of causing myocarditis, initially thought to be a rare occurrence, it had a prevalence as high as 10% when reviewed. A similar pattern may be observed with the covid vaccine;thus, this complication can be significantly underestimated, and physicians must be vigilant. Thus, cardiac MRI should be pursued if clinically suspected. It has been shown to provide reliable clinical information even in the early phases of inflammation as well as the extent of the inflammatory process, and it avoids invasive procedures1 It can also be used prognostically to monitor disease status. Myocarditis may be immune-related. Key observations include increased systemic reactogenicity and immunogenicity in younger study participants in Pfizer-biotech clinical trials. However, another report showed no difference in spike antibody between patients with myocarditis and those without myocarditis post-covid mRNA vaccine, arguing against a hyperimmune response2. Another plausible mechanism is molecular mimicry between the spike protein and self-antigens, showing cross-reactivity between human peptides in the body, including alpha-myosin3, which may explain why only mRNA covid vaccine causes this complication. Currently, there is no causal relationship, but numerous hypotheses are being examined. CONCLUSIONS: Myocarditis must be recognized as a complication of the covid vaccine and a possible differential of chest pain,specifically in young men in the current pandemic.Early referral of cardiac MRI, if unavailable at centers, is essential for diagnosis and prognostication,given the unknown sequela of this disease. Reference #1 M. Giulia Gagliardi and Bruno Polletta Paolo Di Renzi, Gagliardi, M. G., M. Giulia Gagliardi Department of Cardiology and Cardiac Surgery, Polletta, B., Bruno Polletta Department of Cardiology and Cardiac Surgery, Renzi, P. D., & Paolo Di Renzi Department of Radiology Fatebenefratelli-Isola Tiberina Hospital. (1999, January 26). MRI for the diagnosis and follow-up of Myocarditis. Circulation. Retrieved April 13, 2022, from https//www.ahajournals.org/doi/full/10.1161/circ.99.3.457/a Reference #2 Muthukumar, A., Alagarraju Muthukumar Department of Pathology (A.M., Narasimhan, M., Madhusudhanan Narasimhan Department of Pathology (A.M., Li, Q.-Z., Quan-Zhen Li Department of Immunology (Q.-Z.L.), Mahimainathan, L., Lenin Mahimainathan Department of Pathology (A.M., Hitto, I., Imran Hitto https//orcid.org/0000-0002-9928-4175 Department of Pathology (A.M., Fuda, F., Franklin Fuda Department of Pathology (A.M., Batra, K., Kiran Batra Department of Radiology (K.B.), Jiang, X., Xuan Jiang Department of Internal Medicine (Q.-Z.L., Zhu, C., Chengsong Zhu Department of Internal Medicine (Q.-Z.L., Schoggins, J., … Al., E. (2021, June 16). In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mrna vaccine. Circulation. Retrieved March 31, 2022, from https//www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056038 Reference #3 Vojdani, A., & Kharrazian, D. (2020, August). Potential antigenic cross-reactivity between SARS-COV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clinical immunology (Orlando, Fla.). Retrieved March 31, 2022, from https//www.ncbi.nlm.nih.gov/pmc/articles/PMC7246018/ DISCLOSURES No relevant relationships by Aaron Douen No relevant relationships by Sudhanva Hegde No relevant relationships by Marc Sukhoo-Pertab