Myopericarditis and COVID-19 Vaccination

Coronavirus disease of 2019, colloquially known as COVID-19, is a multisystemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most common symptoms of COVID-19 include fever, myalgia, chills, cough, shortness of breath, fatigue, along with anosmia and dysgeusia. SARS-CoV-2 infection can result in simultaneous inflammation in multiple tissues including, and not limited to, pulmonary, renal, central nervous and cardiac organ systems. Cardiac involvement in COVID-19 may be asymptomatic with cardiac biomarker changes and/or electrocardiogram (EKG) changes; or symptomatic. Symptomatic disease may involve one or more functional elements of cardiac tissue e.g., pericardium, myocardium and the conduction system. There are numerous reports of COVID-19 associated myocarditis in the literature [1-3]. The Centers for Disease Control and Prevention's (CDC) definition of a confirmed case of myocarditis is the presence of new or worsening clinical symptoms as listed in Table 1 along with new findings on cardiac magnetic resonance imaging (cMRI) or histopathology and no other identifiable cause of the symptoms and findings [4]. Definitions of acute pericarditis and myopericarditis are also listed in Table 1. For simplicity, the remainder of the manuscript refers to these conditions collectively as myopericarditis. The etiologies of myopericarditis include non infectious causes, such as medication-induced, autoimmune, physical trauma, and infectious causes. Those attributable to infectious agents may be incited by common viruses including influenza and SARS-CoV-2. Myopericarditis may also occur after vaccination against viral diseases such as smallpox [5]. Among viral causes, at the molecular level, whether the virus itself infects cardiac cells resulting in a direct viral insult on cellular machinery or whether an immunologic cascade leads to cellular damage remains elusive. While chest pain is the most common symptom of myopericarditis, other symptoms include fever, sore throat, dyspnea, palpitations, and fatigue.