Myocarditis Following COVID-19 Vaccination

Constantin A Marschner; Kirsten E Shaw; Felipe Sanchez Tijmes; Matteo Fronza; Sharmila Khullar; Michael A Seidman; Paaladinesh Thavendiranathan; Jacob A Udell; Rachel M Wald; Kate Hanneman

doi:10.1016/j.hfc.2022.08.012

Myocarditis Following COVID-19 Vaccination

Heart Fail Clin. 2023 Apr;19(2):251-264. doi: 10.1016/j.hfc.2022.08.012.

Affiliations

¹ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Department of Radiology, University Hospital, LMU Munich, Munich 81377, Germany.
² Department of Graduate Medical Education, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA.
³ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santa Maria 500, Santiago, Chile 7520378.
⁴ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
⁵ Department of Laboratory Medicine & Pathobiology, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada; Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11E-444, Toronto, Ontario M5G 2C4, Canada.
⁶ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G2N2, Canada.
⁷ Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G2N2, Canada; Cardiovascular Division, Women's College Hospital, University of Toronto, 76 Grenville Street, Room 6324, Toronto, Ontario M5G2N2, Canada.
⁸ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 5N-517, 585 University Avenue, Toronto, Ontario M5G2N2, Canada.
⁹ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. Electronic address: kate.hanneman@uhn.ca.

Abstract

Myocarditis is an established but rare adverse event following administration of messenger RNA-based coronavirus disease 2019 (COVID-19) vaccines and is most common in male adolescents and young adults. Symptoms typically develop within a few days of vaccine administration. Most patients have mild abnormalities on cardiac imaging with rapid clinical improvement with standard treatment. However, longer term follow-up is needed to determine whether imaging abnormalities persist, to evaluate for adverse outcomes, and to understand the risk associated with subsequent vaccination. The purpose of the review is to evaluate the current literature related to myocarditis following COVID-19 vaccination, including the incidence, risk factors, clinical course, imaging findings, and proposed pathophysiologic mechanisms.

Keywords: COVID-19; Cardiac MRI; Myocarditis; Vaccine; mRNA vaccine.

Publication types

Review

MeSH terms

Adolescent
COVID-19 Vaccines / adverse effects
COVID-19* / epidemiology
COVID-19* / prevention & control
Heart
Humans
Male
Myocarditis* / etiology
Vaccination / adverse effects
Young Adult

Substances

COVID-19 Vaccines