scholarly journals 553 Myocarditis after COVID-19 vaccination—a case series

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Serena Bricoli ◽  
Giovanna Cacciola ◽  
Federico Barocelli ◽  
Clelia Guerra ◽  
Marco Zardini
Keyword(s):  
Troponin T ◽  
Acute Myocarditis ◽  
Rare Complication ◽  
Previous History ◽  
Case Series ◽  
Acute Chest Pain ◽  
Smallpox Vaccination ◽  
Temporal Association ◽  
Diffuse Infiltration ◽  
St Segment Elevation

Abstract Myocarditis has been recognized as a rare complication of SARS-CoV-2 infection even in the absence of lung involvement and recent histological findings suggest that COVID-19-related myocardial damage may differ from other typical lymphocytic myocarditis associated with other viruses and could be possibly linked to diffuse infiltration of monocytes and macrophage leading to microvascular dysfunction and cell necrosis. SARS-CoV-2 vaccines have been well tolerated and associated with decreasing burden of disease in areas with high vaccination rates. Minor side-effects have been frequently described, mainly after second dose. Here, we report our findings in four male patients consistent with acute myocarditis at our Institutional Hospital; all four had recently received a second-dose mRNA vaccine. All presented with acute chest pain associated with biomarker evidence of myocardial injury and were hospitalized. None of them had a previous history of SARS-CoV2 infection. All of them showed markedly abnormal EKG findings with diffuse ST segment elevation and laboratory tests revealed elevated high-sensitivity (hs) troponin T levels and C-reactive protein with no peripheral eosinophilia. All patients underwent nasopharyngeal swabbing and the specimens were tested for common respiratory viruses by RT-PCR and resulted all negative. All patients underwent CMR scan during hospitalization. The hospital course was benign for all patients without evidence of arrhythmias or heart failure, in all cases we performed a conservative treatment with nonsteroidal anti-inflammatory drugs and colchicine with progressive normalization of troponin levels before discharge. Our cases presented features of acute myocarditis with a temporal association with the mRNA Covid-19 vaccination, in absence of other apparent causes (in fact none had viral prodromes) nor COVID-19 infection in the prior year. Several reports in the past months had suggested a possible association between the mRNA Covid-19 and myocarditis, most of the cases presenting in young males, after the second dose and with a favourable course. Thus, given the potential risk of cardiac involvement after SARS-CoV-2 infection even in younger adults, the risk-benefit decisions favours vaccination for population immunity. Despite this, the potential mechanisms of SARS-CoV-2 vaccine-related myocarditis seem different from the previously described eosinophilic myocarditis after smallpox vaccination remain unclear and vaccine adverse event reporting remains of high importance. Figure 1 shows one acute MRI scan with STIR, T2-map and LGE in short-axis and apical four-chamber view.

scholarly journals Escherichia coli bacteremia due to urinary tract infection complicated by acute myocarditis: A rare complication

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110236
Author(s):  
Mohamadanas Oudih ◽  
Thana Harhara
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Myocarditis ◽  
Rare Complication ◽  
Kidney Injury ◽  
St Segment Elevation ◽  
Infection Treatment ◽  
St Segment

Acute myocarditis is a rare complication of Escherichia coli urinary tract infection and sepsis. We report the case of a previously healthy 55-year-old female who presented to our emergency department with diarrhea and hypotension. The basic metabolic panel results showed an increase in inflammatory markers and an acute kidney injury. Urine and blood cultures grew Escherichia coli. The patient subsequently developed sudden chest pain and shortness of breath, diffuse ST-segment elevation, and cardiac enzymes’ elevation. Coronary angiogram was normal, and transthoracic echocardiogram demonstrated normal ventricular functions. Cardiac magnetic resonance imaging was highly suspicious of myopericarditis. The patient made a full recovery after infection treatment with intravenous antibiotics, aspirin, and colchicine.

scholarly journals A case of coronary artery air embolism in a transplanted heart during cardiac allograft vasculopathy surveillance angiography

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Jeffrey F Spindel ◽  
Vikas Singh ◽  
Mohammad Mathbout
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Rare Complication ◽  
Invasive Coronary Angiography ◽  
Air Embolism ◽  
Acute Chest Pain ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Allograft Vasculopathy ◽  
St Segment Elevation

Coronary air embolism is a rare iatrogenic complication during invasive coronary angiography or angioplasty that can cause acute chest pain, hypotension, ST-segment elevation myocardial infarction, and even death. We present a case of left anterior descending coronary artery air embolization in a 58-year-old heart transplant patient that occurred during cardiac allograft vasculopathy surveillance angiography. The patient was managed successfully with rapid coronary injections of heparinized saline, catheter disengagement to increase coronary blood flow, and supplementation of 100% oxygen to dissolve the coronary air embolus. This case highlights this rare complication of coronary angiography, importance of prompt recognition of the pathology and subsequent management.

Immune-Mediated Neuropathies following Autologous Stem Cell Transplantation for Multiple Myeloma: Case Series and Review of the Literature

2017 ◽  
Vol 137 (2) ◽  
pp. 86-88 ◽  
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Jacqueline Uy ◽  
Honhar Medhavi ◽  
Muhammad Salman Faisal ◽  
Muzaffar H. Qazilbash
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Rare Complication ◽  
Case Series ◽  
Common Finding ◽  
Temporal Association ◽  
Hematopoietic Stem ◽  
Immune Mediated

Neuropathy is a common finding in patients with multiple myeloma. Several different factors can cause neuropathy in these patients, such as the underlying disease itself, medications used for treatment, or immune-mediated processes. Immune-mediated neuropathies (IMN) consist of a heterogeneous spectrum of peripheral nerve disorders. Although IMN is associated with several hematological disorders, it remains a very rare complication of hematopoietic stem cell transplantation (HCT). We describe our experiences of 3 patients with multiple myeloma who experienced IMN following autologous HCT (auto-HCT). These 3 patients were felt to have IMN clearly attributable to auto-HCT because of a clear temporal association with auto-HCT and absence of any other obvious causative factor. The variety in their clinical presentations, diagnostic approach, and approaches to management are explained. The pathophysiology of how HCT may predispose to IMN remains poorly understood. Our report helps highlight several potential causes of this phenomenon, such as a paraneoplastic syndrome, immune reconstitution syndrome, or drug toxicity. We emphasize that a comprehensive approach is needed to address this rare entity, and that there should be a low threshold to initiate immune-specific therapy, such as plasmapheresis, if symptoms do not resolve spontaneously.

scholarly journals Acute Myocarditis in a Patient with Newly Diagnosed Granulomatosis with Polyangiitis

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Anne Munch ◽  
Jens Sundbøll ◽  
Søren Høyer ◽  
Manan Pareek
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Troponin T ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Dose ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Cardiac Symptoms

A 22-year-old woman recently diagnosed with granulomatosis with polyangiitis (GPA) was admitted to the department of cardiology due to chest pain and shortness of breath. The ECG showed widespread mild PR-segment depression, upwardly convex ST-segment elevation, and T-wave inversion. The troponin T level was elevated at 550 ng/L. Transthoracic echocardiography showed basal inferoseptal thinning and hypokinesis, mild pericardial effusion, and an overall preserved left ventricular ejection fraction of 55%. Global longitudinal strain, however, was clearly reduced. Cardiac magnetic resonance imaging (MRI) showed findings consistent with myocarditis but the etiology of the apical hypokinesis could not be determined with certainty and may well have been due to a myocardial infarction, a notion supported by a coronary angiogram displaying slow flow in the territory of the left anterior descending artery. Finally, an endomyocardial biopsy confirmed the diagnosis of myocarditis. The cardiac symptoms subsided upon treatment with high-dose prednisolone and rituximab.

scholarly journals A report of two cases of myocarditis following mRNA COVID-19 vaccination

2022 ◽  
Author(s):  
Christopher Paul Bengel ◽  
Rifat Kacapor
Keyword(s):  
Heart Failure ◽  
Adverse Reaction ◽  
Chest Pain ◽  
Clinical Presentation ◽  
Acute Myocarditis ◽  
Rare Complication ◽  
Case Series ◽  
Clinical Suspicion ◽  
Case Summary ◽  
Causative Factors

Abstract Background Vaccination is the most important measure to control the coronavirus disease 2019 (COVID-19) pandemic. Myocarditis has been reported as a rare adverse reaction to COVID-19 vaccines. The clinical presentation of myocarditis in such cases can range from mild general symptoms to acute heart failure. Case summary We report the cases of two young men who presented with chest pain and dyspnoea following the administration of the mRNA COVID-19 vaccine. Cardiac investigations revealed findings typical of acute myocarditis. Discussion Myocarditis is a rare complication following mRNA COVID-19 vaccination. In this case series, the temporal proximity of the development of acute myocarditis and the administration of the mRNA COVID-19 vaccine was acknowledged. In the absence of other causative factors, myocarditis in these patients potentially occurred due to an adverse reaction to the mRNA COVID-19 vaccine. However, a causal relationship remains speculative. Clinical suspicion of myocarditis should be high if patients present with chest pain or dyspnoea after receiving COVID-19 vaccination.

Time from symptom onset influences high-sensitivity troponin T diagnostic accuracy for the diagnosis of acute myocardial infarction

2016 ◽  
Vol 54 (1) ◽  
Author(s):  
Li Guangquan ◽  
Huang Hualan ◽  
Nie Xin ◽  
He Yong ◽  
Song Haolan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Diagnostic Accuracy ◽  
Symptom Onset ◽  
Diagnostic Performance ◽  
Troponin T ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Time Required

AbstractThe time required for patients with acute chest pain to reach a hospital emergency department varies, possibly lowering the diagnostic performance of a general cut-off value for high-sensitivity cardiac troponin T (hs-cTnT) in diagnosing acute myocardial infarction (AMI). The aim of this study was to determine the cut-off values as calculated by receiver operating characteristic (ROC) of hs-cTnT at different times from onset of symptoms to admission, and to evaluate their diagnostic performance.Our study included 3096 patients with symptoms suggestive of AMI. These patients were classified according to time from onset of symptoms to admission. The diagnostic accuracy was quantified by the area under the ROC curve (AUC).Of the patients, 1082 (49.3%) were diagnosed as having AMI (317 were non-ST segment elevation myocardial infarction [NSTEMI]). The AUC for hs-cTnT to diagnose AMI was 0.881 at <3 h after symptom onset, 0.940 at 3–6 h after symptom onset, 0.966 at 6–12 h after symptom onset, and 0.974 at >12 h after symptom onset. The threshold as determined by ROC of hs-cTnT was 13.5 ng/L to diagnose AMI at ≤3 h after symptom onset with a sensitivity of 81.8% and a specificity of 80.1%, 17.8 ng/L at 3–6 h after symptom onset with a sensitivity of 94.6% and a specificity of 84.3%, 30.0 ng/L at 6–12 h after symptom onset with a sensitivity of 95.9% and a specificity of 85.5%, and 58.0 ng/L at >12 h after symptom onset with a sensitivity of 92.7% and a specificity of 93.3%. The same observations were performed for the diagnosis of NSTEMI.The ROC-determined cut-off value of hs-cTnT for AMI or NSTEMI diagnosis gradually increased with time from onset of symptoms to presentation. Using a higher cut-off value by ROC for hs-cTnT will improve its accuracy in diagnosing AMI or NSTEMI patients in late presenters. The higher value will enable physicians to more quickly rule in patients compared to the 99th percentile cut-off, and can rule out patients safely.

scholarly journals The de Winter Pattern as Pre-Anterior ST-Elevation-Myocardial-Infarction. “An Evolution Sequence”: A Case Report

2021 ◽  
Vol 42 (2) ◽  
Author(s):  
Muhammad Surya Tiyantara ◽  
Djoen Herdianto
Keyword(s):  
Myocardial Infarction ◽  
Troponin T ◽  
Previous History ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Evolution Sequence

Introduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI. Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit. Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome.

scholarly journals Ocular inflammatory events following COVID-19 vaccination: a multinational case series

2021 ◽  
Author(s):  
Ilaria Testi ◽  
Camilo Brandão-de-Resende ◽  
Rupesh Agrawal ◽  
Carlos Pavesio
Keyword(s):  
Previous History ◽  
Case Series ◽  
Visual Outcome ◽  
Posterior Uveitis ◽  
Cystoid Macular Oedema ◽  
Temporal Association ◽  
Inflammatory Event ◽  
Inflammatory Conditions ◽  
History Of ◽  
The Mean

Abstract Background Inflammatory adverse events following COVID-19 vaccination are being reported amidst the growing concerns regarding vaccine’s immunogenicity and safety, especially in patients with pre-existing inflammatory conditions. Methods Multinational case series of patients diagnosed with an ocular inflammatory event within 14 days following COVID-19 vaccination collected from 40 centres over a 3 month period in 2021. Results Seventy patients presented with ocular inflammatory events within 14 days following COVID-19 vaccination. The mean age was 51 years (range, 19-84 years). The most common events were anterior uveitis (n = 41, 58.6%), followed by posterior uveitis (n = 9, 12.9%) and scleritis (n = 7, 10.0%). The mean time to event was 5 days and 6 days (range, 1-14 days) after the first and second dose of vaccine, respectively. Among all patients, 36 (54.1%) had a previous history of ocular inflammatory event. Most patients (n = 48, 68.6%) were managed with topical corticosteroids. Final vision was not affected in 65 (92.9%), whereas 2 (2.9%) and 3 (4.3%) had reduction in visual acuity reduced by ≤ 3 lines and > 3 lines, respectively. Reported complications included nummular corneal lesions (n = 1, 1.4%), cystoid macular oedema (n = 2, 2.9%) and macular scarring (n = 2, 2.9%). Conclusion Ocular inflammatory events may occur after COVID-19 vaccination. The findings are based on a temporal association that does not prove causality. Even in the possibility of a causal association, most of the events were mild and had a good visual outcome.

scholarly journals Stress cardiomyopathy (Takotsubo) following radioactive iodine therapy

2015 ◽  
Vol 2015 ◽  
Author(s):  
Anastasia Dimakopoulou ◽  
Karunakaran Vithian ◽  
David Gannon ◽  
Allan Harkness
Keyword(s):  
Radioactive Iodine ◽  
Troponin T ◽  
Rare Complication ◽  
Stress Cardiomyopathy ◽  
List Type ◽  
Radioactive Iodine Therapy ◽  
St Segment Elevation ◽  
St Segment ◽  
Menopausal Women ◽  
Post Menopausal

Summary A 55-year-old female patient presented to the endocrine clinic with Grave's disease. She was initially treated with carbimazole. After an early relapse, a decision was made to proceed with radioactive iodine therapy. Four days after radioiodine administration, she presented to the emergency department with chest tightness and dyspnea due to heart failure. Biochemistry revealed thyrotoxicosis and significantly elevated Troponin-T. There was ST segment elevation on electrocardiography. However, coronary angiography was normal. Ventricular function was fully restored after 6 weeks of supportive medical management. A diagnosis of stress cardiomyopathy following radioactive iodine therapy was made. This is the second case reported in the literature so far to the best of our knowledge. Learning points Stress cardiomyopathy in the context of radiation thyroiditis is a rare complication following radioiodine therapy. A degree of awareness is essential because the approach is multidisciplinary. Management is mainly supportive and cardiac dysfunction is completely reversible in most cases. The pathogenesis of this condition remains unclear. Post-menopausal women and susceptible individuals appear to be pre-disposed.

scholarly journals Ocular inflammatory events following COVID-19 vaccination: a multinational case series

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ilaria Testi ◽  
Camilo Brandão-de-Resende ◽  
Rupesh Agrawal ◽  
Carlos Pavesio ◽  
Laura Steeples ◽  
...  
Keyword(s):  
Previous History ◽  
Case Series ◽  
Visual Outcome ◽  
Posterior Uveitis ◽  
Cystoid Macular Oedema ◽  
Temporal Association ◽  
Inflammatory Event ◽  
Inflammatory Conditions ◽  
History Of ◽  
The Mean

Abstract Background Inflammatory adverse events following COVID-19 vaccination are being reported amidst the growing concerns regarding vaccine’s immunogenicity and safety, especially in patients with pre-existing inflammatory conditions. Methods Multinational case series of patients diagnosed with an ocular inflammatory event within 14 days following COVID-19 vaccination collected from 40 centres over a 3 month period in 2021. Results Seventy patients presented with ocular inflammatory events within 14 days following COVID-19 vaccination. The mean age was 51 years (range, 19–84 years). The most common events were anterior uveitis (n = 41, 58.6%), followed by posterior uveitis (n = 9, 12.9%) and scleritis (n = 7, 10.0%). The mean time to event was 5 days and 6 days (range, 1–14 days) after the first and second dose of vaccine, respectively. Among all patients, 36 (54.1%) had a previous history of ocular inflammatory event. Most patients (n = 48, 68.6%) were managed with topical corticosteroids. Final vision was not affected in 65 (92.9%), whereas 2 (2.9%) and 3 (4.3%) had reduction in visual acuity reduced by ≤3 lines and > 3 lines, respectively. Reported complications included nummular corneal lesions (n = 1, 1.4%), cystoid macular oedema (n = 2, 2.9%) and macular scarring (n = 2, 2.9%). Conclusion Ocular inflammatory events may occur after COVID-19 vaccination. The findings are based on a temporal association that does not prove causality. Even in the possibility of a causal association, most of the events were mild and had a good visual outcome.

Sign in / Sign up

Export Citation Format

Share Document