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2022-10-17

Cardiac Complications Following COVID-19 and Vaccination

Did you know that COVID patients have nearly 16 times the risk of developing myocarditis compared to those not infected with COVID?

Cardiac disease and COVID-19 consequences

Patients with cardiac disease who develop COVID-19 are at higher risk of experiencing severe infection, complications, and death. In one systematic literature review, COVID-19 patients were more than three times as likely to die, experience severe disease, or be transferred to the intensive care unit and/or be placed on a ventilator. And in a report from the Chinese Centre for Disease Control and Prevention, the case fatality rate in patients with COVID-19 and cardiac disease (10.5 percent) was more than four times the overall mortality rate (2.3 percent).

Myocarditis and pericarditis are complications of COVID-19 infection. While most cases of myocarditis resolve on their own, it sometimes recurs and can lead to dilated cardiomyopathy. Pericarditis, though not generally serious itself, can cause serious health issues. These and other cardiovascular complications of COVID-19 are greatly increasing the burden of morbidity and mortality in adult patients.

Myocarditis and pericarditis have also been reported in adolescents and young adults following administration of mRNA SARS CoV-2 vaccines, primarily in male adolescents after the second dose of mRNA vaccine. This occurs rarely: according to a CDC estimate, the incidence of myocarditis due to mRNA vaccination is 1.2 per 100,000 doses in the 18-29 population.

Patients usually experience symptoms (chest pain, shortness of breath, sensation of fluttering or pounding heart) during the first week after being vaccinated. Most patients recover quickly with treatment and can resume regular activities of daily living once they have recuperated. Short-term follow up at between three and six months suggests that patients generally make a full recovery with no further symptoms and normal ventricular function (though those who have suffered myocarditis should check with a cardiologist before restarting athletic activities). Death following myocarditis is rare; an international review of mortality after COVID-19 vaccination found only two confirmed cases of myocarditis-induced fatality. In spite of the mRNA vaccine-related risk of myocarditis and pericarditis, it seems that the risk is well worth the benefit of preventing infection with COVID-19.

While the benefits of vaccination probably outweigh the risk of myocarditis and pericarditis for the general population, we cannot be sure that the same is true for a particular population: patients with cardiac disease. Are they more vulnerable to COVID-19? Should they be vaccinated? And what role can healthcare providers play in monitoring and managing heart disease patients following vaccination and during and after COVID-19 infection?

COVID-19 vaccination in patients with heart disease

The currently available evidence suggests that vaccination is an option for patients living with heart disease. First, myocarditis and pericarditis are rare consequences of COVID-19 vaccination. Secondly, they primarily occur in individuals less than thirty years of age, whereas cardiovascular disease is more likely to occur in those who are at least 65 years of age. Finally, the greater risk of severe illness and death due to COVID-19 among individuals with heart disease suggests that the small risk of myocarditis and pericarditis is preferable to the chances of developing cardiac complications because of contracting COVID-19.

The role of healthcare providers

After vaccination

Healthcare professionals can encourage patients to self-monitor for symptoms of myocarditis and pericarditis (chest pain, palpitations, shortness of breath) following immunization and to seek medical attention if they experience these symptoms. For any suspected case of myocarditis or pericarditis, consult with a cardiologist. Treatment can include supportive care, NSAIDs, colchicine, steroids, and intravenous immunoglobulin and steroids for patients up to 18 years of age.

During COVID-19 infection

As the majority of cases are mild and do not require medical measures or hospitalization, many patients can be assessed remotely. However, clinicians should be alert for any symptoms suggestive of cardiac disease in outpatients.

In hospitals, healthcare providers should conduct a targeted cardiac evaluation for patients with COVID-19 who develop one or more of the common cardiac complications of the disease (including heart failure or cardiac arrhythmia).Supportive cardiac care is recommended for these patients.

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Related:

Explore Clinical Paper Highlights on Bench to Practice: Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination Bench to Practice is a new educational hub for up-to-date clinical research and resources for healthcare professionals. The Clinical paper highlights section provides comprehensive summaries of recent clinical papers in 10 minutes. Explore more paper highlights here.