Yes, it is true: myocarditis can become inflamed after vaccination. But if such a situation occurs at all, and it happens so rarely, the disease is mild and ends in recovery quickly – emphasizes prof. Artur Mamcarz, head of the XNUMXrd Department of Internal Diseases and Cardiology at the Medical University of Warsaw (MUW). How does heart inflammation occur and what indicates that it has passed?
- After contracting COVID-19, myocarditis occurs much more often than after vaccination – emphasizes Prof. Artur Mamcarz
- The doctor reminds that all the described post-vaccination myocarditis was mild and resulted in a quick recovery.
- Severe myocarditis is associated with viral infections, including smallpox, herpes zoster, hepatitis, mumps, influenza, as well as SARS-CoV-2
- Passing myocarditis may be evidenced by greater fatigue, shortness of breath with little activity, e.g. the patient cannot climb stairs, has a feeling of palpitations, shortness of breath, chest pains. – It is worth reporting such symptoms to a doctor who will make a diagnosis or order tests – recommends prof. Mamcarz
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Head of the XNUMXrd Department of Internal Diseases and Cardiology of the Medical University of Warsaw, member of the board of the Polish Society of Lifestyle Medicine, member of the board of the Polish Association for the Treatment of Obesity, member of the Medical Committee of POKI. Author of numerous monographic studies in the field of cardiology.
Monika Wysocka: How often does myocarditis occur?
Prof. Artur Mamcarz, cardiologist: We do not have precise data on the frequency of its occurrence, including because myocarditis with serious consequences is very rare. The point is that while in the case of a heart attack or hypertension, the diagnosis is based on some fairly obvious procedures (e.g. blood pressure measurement, ECG, or exercise test), a biopsy would be needed to reliably diagnose myocarditis. hearts. And this is an invasive test, so it is only performed when necessary.
In addition to a biopsy, how can we find out if there is inflammation of the heart muscle?
Since some visible changes in the heart muscle occur during viral infection, an EKG, echocardiogram, or magnetic resonance imaging is performed to make the diagnosis. A Holter may also be placed on the patient to see if the inflammation is accompanied by a cardiac arrhythmia. Laboratory tests, which show elevated ESR or an increase in the concentration of the CK (creatine kinase) enzyme or troponins, which are released from damaged muscle cells, also confirm the inflammatory process. These kinds of results could be a sign of inflammation.
- How to prepare for a Holter EKG?
It sounds pretty scary. Is it a serious disease?
It all depends on the severity of the inflammation. The course of this disease can vary: from a very mild, even subclinical, which sometimes we do not even know it happened, to one with an electrifying course that is hard to miss, related to severe damage to the heart muscle cells.
In the former case, usually no tests are performed because nothing much is happening to the person.
What does that mean exactly?
That a person experiences certain “ethereal” symptoms, such as chest pains or deterioration of exercise tolerance, which pass over time, and that’s it. A bit annoying but harmless.
But sometimes it’s worse …
The more cells in the heart are damaged, the more severe and dynamic the symptoms become. If there are cardiac arrhythmias, we must intervene depending on their severity: implant a cardioverter – defibrillator, and even qualify the patient for a heart transplant, because this is the only way to save him. But such situations are extremely rare. We had such a case in our clinic over a year ago: a 50-year-old patient with a low ejection fraction and potentially fatal arrhythmia came to us. She had a cardiovascular arrest in her ward and we had to make a decision about the implantation of a cardioverter. But these are really individual cases.
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How does such inflammation of the heart come about?
It has been linked to viral infections. Most often it is caused by enteroviruses, especially the Coxsackie type B virus. Other viruses responsible for the occurrence of myocarditis include Epstein-Barr virus, cytomegalovirus, smallpox, herpes zoster, hepatitis, mumps and influenza. The pathogenic agent can also be protozoa of the genus Toxoplasma and bacteria, e.g. coryneforme diphtheria.
The SARS-CoV-2 virus, which has been discussed for a long time, can also cause myocarditis. It is considered that during an epidemic such as influenza, 3 to 5 percent. patients who have an infection of the upper respiratory tract have various “cardiac” symptoms and changes in the EKG.
What indicates a history of myocarditis?
When after an infection, mild or more intense, a patient experiences a sudden deterioration of exercise tolerance: he gets tired more easily, he is short of breath with little activity, e.g. he cannot climb stairs, he has a feeling of palpitations, shortness of breath, chest pain. It is worth reporting such symptoms to a doctor who will make a diagnosis or order tests. Such symptoms may well appear after an infection without affecting the heart. Then you have to look for the cause.
People who complain of chest pain should use the cardiology package. The package includes both a consultation with a cardiologist and an ECG. The package is available in a private Arkmedic facility.
If myocarditis is inflamed, what are the consequences of this?
Most of the time, symptoms go away and everything returns to normal. The ailments are so weak that the patient does not even go to the doctor.
Sometimes the damage is permanent and leads to heart failure, sometimes, as I mentioned, heart rhythm disturbances require the implantation of a cardioverter defibrillator.
In less severe cases, the patient is advised to rest, sleep, slow down a little, avoid exercise, and reduce the consumption of alcohol and cigarettes. If the course of inflammation was more severe, the patient is treated with anti-inflammatory steroids, but not with non-steroidal anti-inflammatory drugs, which in this situation should rather be avoided because they may, especially in the acute phase, increase the inflammation.
Are there any predispositions to such a reaction to an infection?
People with a compromised immune system have an increased risk of getting sick with any infection. Likewise, people with autoimmune diseases. As for other people, it is difficult to say to whom this complication will happen.
Some people believe that vaccination against COVID-19 causes inflammation of the heart muscle. How often does this happen?
I will answer it this way: this is primarily the threat posed by the SARS-CoV-2 virus. After contracting COVID-19, myocarditis occurs much more often than after vaccination. We are still learning about this disease, we do not fully know all its mechanisms, but we already know for sure that a certain group of people develop long covid after contracting COVID-19, in which one of the ailments is myocarditis manifested by chronic fatigue, palpitations, rapid heartbeat, arrhythmias.
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However, this is extremely rare after vaccination.
The situation is similar to thrombotic complications, which in the case of COVID-19 infection in patients treated in hospital occur in up to 70%, and after vaccination – yes, but several thousand times less often.
It is also worth adding that all the described myocarditis that occurred after vaccination was mild and resulted in a quick recovery, so do not worry about them.
A greater risk is posed by over-the-counter non-steroidal anti-inflammatory drugs, which have a great potential for side effects such as gastric irritation, gastric ulcer, gastrointestinal bleeding, pressure increase, stroke, etc. These complications occur once in 2,5 thousand and few people care about it, and we get excited about minor vaccine complications, which occur once in 250-300 thousand.
Interviewed by Monika Wysocka, zdrowie.pap.pl
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