Reports of myocarditis/pericarditis after COVID-19 vaccination

To date, no clear association has been established between myocarditis/pericarditis and COVID-19 vaccines,1 as the rates of myocarditis/pericarditis are not any higher than would normally be expected in the general population. However, as of June 11, 2021, 53 case reports of myocarditis/pericarditis following COVID-19 vaccination had been submitted to the Public Health Agency of Canada or Health Canada. Of these cases, 40 patients received Pfizer-BioNTech COVID-19 vaccine, eight received the Moderna vaccine, four received the Oxford-AstraZeneca/Covishield vaccine, and the vaccine was not identified in the remaining case. Symptom onset ranged from five hours to 92 days after receiving the vaccine. Myocarditis/pericarditis occurred after the first vaccine dose in 33 cases, after the second dose in 13 cases and was not specified in seven cases.2 International reports of myocarditis/pericarditis after COVID-19 vaccination suggest that: Cases are more common after the second dose Symptom onset is usually within several days after vaccination Cases occur mainly in adolescents and young adults Cases are more common in males than females Most patients experience mild illness, respond well to rest and conservative treatment and improve quickly.2 Symptoms Myocarditis involves inflammation of the heart muscle, while pericarditis involves inflammation of the sac surrounding the heart. Symptoms can include shortness of breath, chest pain or the feeling of a rapid or abnormal heart rhythm. Healthcare professionals should consider the possibility of myocarditis or pericarditis when evaluating patients for acute chest pain or pressure, arrhythmias, shortness of breath or other clinically compatible symptoms after COVID-19 vaccination.2 Management Suspected cases of post-vaccination myocarditis/pericarditis should be assessed in person by a physician. If clinically concerned about the presence of myocarditis/pericarditis, consult with a cardiologist, who may consider doing an electrocardiogram, troponins or an echocardiogram. Other potential causes of myocarditis and pericarditis should also be ruled out. Consultation with an infectious diseases specialist and/or rheumatologist may be needed.2 Generally, post-vaccination myocarditis/pericarditis is a mild disease that self-resolves. Mild cases may be treated with non-steroidal anti-inflammatory drugs to provide symptomatic relief. Moderate to severe cases may require additional treatments; consult with a cardiologist, an infectious diseases specialist and a rheumatologist, as needed. Patients with abnormal cardiology investigations may require further follow-up by a cardiologist.2 To date, the small number of cases seen among adolescents have been mild and resolved without any concerns about potential long-term complications. However, moderate to severe myocarditis/pericarditis may require more extensive investigation and longer follow-up by a cardiologist. Myocarditis/pericarditis after first vaccine dose Until further information on this condition becomes available, if a patient develops myocarditis/pericarditis after their first dose of COVID-19 vaccine, the decision to administer the second vaccine dose should be made on a case-by-case basis. Consultation with an infectious diseases specialist is recommended.2 References 1. Public Health Agency of Canada. Canadian COVID-19 vaccination safety report. Ottawa: Public Health Agency of Canada; May 28, 2021 (accessed June 22, 2021). 2. Sick Kids. Reports of myocarditis/pericarditis after COVID-19 vaccination. FAQ for health-care providers. June 16, 2021 (accessed June 22, 2021).

Reports of myocarditis/pericarditis after COVID-19 vaccination

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