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Last week, the European Medicines Agency confirmed that myocarditis and pericarditis may be rare side effects following vaccination with Pfizer or Moderna. Such NOPs mainly affect younger men. What are these conditions and how serious are they? For MedTvoiLokona, Dr. Bartosz Hudzik, a cardiologist, explains.
- In Poland, pericarditis or myocarditis after vaccination against COVID-19 was diagnosed in a total of 13 people until July 10th. 9 of them are men
- The symptoms of myocarditis include: chest pain or discomfort
- Such symptoms require contact with a physician who should refer the patient to a cardiologist. Treatment takes place in a hospital
- More information can be found on the Onet homepage.
He is a cardiologist and specialist in internal medicine.
And also an employee:
- III Department and Clinical Department of Cardiology of the Silesian Center for Heart Diseases in Zabrze
- Department of Cardiovascular Diseases Prevention in Bytom, Medical University of Silesia in Katowice
Agnieszka Mazur-Puchała, Medonet: Last week, EMA informed that myocarditis or pericarditis may occur after the second dose of Pfizer and Moderna vaccines. Such a severe NOP is supposed to affect mainly younger men. Regardless of vaccines, are these conditions also more common in this group?
Dr hab. Bartosz Hudzik, cardiologist: Viral infections are the most common cause of myocarditis. There are many viruses that can lead to them. Myocarditis most often develops in the course of respiratory tract infections, but also viral gastrointestinal infections (often with diarrhea) can contribute to the development of myocarditis. These viruses either have affinity for the heart muscle. In some cases, however, myocarditis persists despite the disappearance of viral symptoms – in such cases, the inflammatory process within the heart muscle occurs as a result of an overreaction of the immune system. In many cases, it is not possible to establish an unequivocal cause of the disease.
In fact, after what I see in clinical practice, younger people are more likely to suffer from this condition. Indeed, they are more often, but not always, men. The age range is between 20 and 40 years of age, but more often these are people between 20 and 35 years of age. Less common etiologies of myocarditis include bacterial inflammations (e.g. in the course of Lyme disease or chlamydial infections), parasitic ones (e.g. in toxoplasmosis), or in the course of autoimmune diseases (e.g. systemic lupus erythematosus, connective tissue diseases, sarcoidosis).
There have been more cases of myocarditis in the last decade than before, although we are not sure if this is actually due to the increase in the number of cases. This may have coincided with the widespread use of cardiac MRI in the diagnosis of myocarditis. In previous decades, the condition may have simply been undiagnosed.
- pain in the chest
- irregular or fast heartbeat
- shortness of breath at rest or with little effort
And what do we know today about myocarditis and pericarditis after mRNA vaccines?
In the world literature, reports of myocarditis, pericarditis or both of these diseases occurring simultaneously after vaccination with mRNA preparations, i.e. Comirnata (Pfizer / BioNTech) or Spikevax (Moderna) vaccines, have appeared in the world literature since March. They were developing after the second dose within a few days of vaccination. In fact, we also know that the overwhelming majority of these adverse vaccine reactions were in younger men.
On July 9, 2021, the Safety Committee of the European Medicines Agency (EMA) presented an analysis of cases of myocarditis and / or pericarditis following vaccination with mRNA preparations (Comirnaty, Spikevax). We analyzed 164 cases of myocarditis (Comirnaty – 145 cases; Spikevax – 19 cases) and 157 cases of pericarditis (Comirnaty – 138 cases; Spikevax – 19 cases) occurring in the European Economic Area (EEA) by 31 May 2021. During this time, 177 million doses of Comirnata and 20 million Spikevax vaccines were administered. The Committee concluded that the majority of episodes of myocarditis / pericarditis occur within the two weeks following vaccination, mainly after the second dose and mainly in young men. The Committee identified five deaths in the EEA area. These deaths occurred in the elderly or those with comorbidities.
The EMA Committee recommended that myocarditis and / or pericarditis be included as a rare complication after vaccination with mRNA preparations. At the same time, the Committee’s experts did not find any cases of myocarditis and / or pericarditis after vaccination with Janssen (Johnson & Johnson) and Vaxzevria (AstraZeneca).
Even before the announcement of the European Medicines Agency, a position of the American Heart Association (AHA) appeared, in which experts recommend to closely monitor patients who, after vaccination with mRNA preparations, report to a doctor with symptoms that may suggest myocarditis or pericarditis. The AHA recommendations are based on a report by the US Centers for Disease Control (CDC). At the end of May 2021, CDC experts noted 789 cases of myocarditis, 475 of which occurred in people <30 years of age. (79 cases were reported in people aged 16-17 years and 196 cases were reported in people aged 18-24). The CDC also noted that myocarditis was observed after vaccination with mRNA preparations (Comirnaty, Spikevax), mainly a few days after the second dose, mostly in young men. In most cases, the clinical course of myocarditis is similar to that not related to vaccination and required rest and supportive care.
Have you been infected with COVID-19 and are worried about the side effects? Check your health by performing a comprehensive test package for convalescents.
What symptoms are we talking about? What should we pay attention to?
Such disturbing symptoms that require consultation with a doctor are pain, pressure or discomfort in the chest. Occasionally, shortness of breath or palpitations may also appear, which are indicative of additional heart rhythm disturbances in the patient.
When patients report these symptoms, they should be tested for myocarditis or pericarditis. Such a basic one is the determination of troponin levels (markers of myocardial necrosis), electrocardiography, echocardiography and possibly cardiac resonance imaging.
What is the prognosis for patients who develop myocarditis or pericarditis after vaccination?
According to a report from the United States, out of almost 800 people with myocarditis by the end of May, 80 percent. patients has already been cured. In the case of 20 percent. treatment was ongoing or there were no data on their health. Taking into account European and American data, it seems that myocarditis after vaccinations is a largely self-limiting disease. In most cases, it did not lead to complications directly. However, we have to wait for the results of long-term follow-up of these patients.
Patients were usually treated with supportive care – the recommendation was to rest. Some patients were receiving colchicine or non-steroidal anti-inflammatory drugs. In some cases, mainly among adolescents under 18 years of age, immunoglobulins were administered, and in individual cases also steroids.
Both the US CDC and the American Heart Association have described such complications as rare. Of the nearly 150 million people vaccinated with the second dose, only nearly 800 people had myocarditis or pericarditis.
This careful observation of adverse vaccine reactions allowed us to identify a new health problem. However, it certainly requires caution on the part of family doctors and quick referral of such patients to cardiologists. Such a patient requires observation and treatment. Most likely in a hospital setting, not at home.
Also read:
- Pericarditis and myocarditis following vaccines. How many cases in Poland? [WE CHECK]
- Vaccination map in Europe. The fourth wave will depend on it
- Side effects of COVID-19 vaccines [COMPARISON]
- “Vaccinations work”. Prof. Filipiak analyzes data from Israel and Great Britain
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