Myopericarditis and Acute Aortic Dissection after Receiving mRNA Based COVID 19 Vaccine: Cases Report and Literature Reviewed

Authors

  • Gumpanart Veerakul Preventive Cardiology Clinic, Bangkok Heart Hospital
  • Lertlak Chaothawee Cardiac Imaging Unit, Bangkok Heart Hospital
  • Apiradee Kridakara Department of Radiology, Bhumibol Adulyadej Hospital
  • Watit Watanasupt Sukumvit Hospital, Thailand

Keywords:

pericarditis, myocarditis, myopericarditis, acute aortic dissection, adverse effect after second MRNAbased vaccine

Abstract

The fastest ever seen, pandemic spreading of the new corona virus, SAR-CoV-2, so-called COVID-19, rapidly infected more than five million cases globally within two years; and created enormous burden to socio-economic and public health systems worldwide. This impact forced vaccine pharmaceutical companies to use newer technology, by using synthetic mRNA, injecting into host body to produce spike proteins and later antibody against them, in faster and cheaper ways than the conventional live attenuated vaccine. Although mRNA based vaccines were prematurely approved for emergently used, preliminary and later studies confirmed their safety and efficacy to prevent previous viral variants, from alpha to delta strains, in over 90%, in comparison to placebo group. After widely used in large population worldwide, several adverse effects had been reported, from anaphylaxis, myopericarditis, stress induced cardiomyopathy, bone marrow failure, ruptured arterial aneurysm and death. We reported five cases of pericarditis (2), myopericarditis (2), myocarditis(1), occurring from 2 to 56 days (average 22, median 14 days) after second vaccine exposure (four cases after Pfizer and Moderna vaccines) and first dose (one case after Moderna half dose), with relative high age [average 49.5 (20-67), median of 55 years]. Clinical manifestations varied from asymptomatic to chest pain, dyspnea, palpitation which resolved within three months. However, one of them had DeBakey type 1 acute aortic dissection of silent fusiform abdominal aortic aneurysm, size 4 cm, and became hypotensive, shock required emergent but uneventful vascular repair. Up to our knowledge this is the first report of these adverse cardiovascular effects of mRNA based vaccine in Thai people. We hoped that this paper will urge medical attention to monitor, early detect and prevent these serious conditions.

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References

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382(18):1708-20.

World Health Organization. Novel coronavirus (2019- nCoV) WHO situation report - 1, 21 January 2020 [Internet]. [cited 2022 Jan 2). Available from: https:// www.who.int

World Health Organization Thailand. Situation update No. 198 August 26, 2021 [Internet]. [cited 2022 Jan 2]. Available from: https://www.who.int/thailand

Qiu P, Zhou Y, Wang F, Wang H, Zhang M, Pan X, et al. Clinical characteristics, laboratory outcome characteristics, comorbidities, and complications of related COVID-19 deceased: a systematic review and meta-analysis. Aging Clin Exp Res 2020;30(9):1–10.

Mehraeen E, Karimi A, Barzegary A, Vahedib F, Afsahid AM, Dadrase), et al. Predictors of mortality in patients with COVID-19-a systematic review. Eur J Integr Med [Internet]. 2020 [cited 2022 May 20];40:101226. Available from: doi: 10.1016/j.eujim.2020. 101226

Nikoloski Z, Alqunaibet AM, Alfawazal RA, Alumudarra SS, Herbst CH, El-Scharty E, et al COVID-19 and non-communicable diseases: evidence from a systematic literature review. BMC Public Health [Internet]. 2021 [cited May 2022];21:1068. Available from: https://doi.org/10.1186/s12889-021-11116-w

Polack FP, Thomas SJ, Kitchin N, Abstalon J, Gurtman A, Lockhart S. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383(27): 2603-15.

Thomas SJ, Moreira Jr, Kitchen N, Abstalon J, Gurtman A, Lockhart S. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine through 6 months. N Engl J Med 2021;385(19):1761-73.

Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021;384(5):403- 16.

Shimabukuro TT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19 caccines in the US — December 14, 2020 - January 18, 2021. JAMA 2021;325(11):1101-2.

Yamamura H, Ischikawa H, Otsuka K, Kasayuki N. Reverse Takotsubo cardiomyopathy as a cause of acute chest pain in a young woman following COVID-19 vaccination. Circ Cardiovasc Imaging 2022;15(1): e013661.

Montgomery J, Ryan M, Engler R, Hoffman D, McClenathan B, Collins L, et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military. JAMA Cardiol 2021; 6(10):1202-6

Myocarditis and Pericarditis Following Vaccinationwith COVID-19 mRNA Vaccines in Ontario:Weekly summary: adverse events following immunization (AEFIs) for COVID-19 in Ontario: December 13, 2020 to November 21, 2021 [Internet]. [cited 2022 April 20]. Available from: https://www.publichealthontario.ca/-/ media/documents/ncov/epi/covid-19-aefi-report.pdf?la=en

Verma AK, Lavine KJ, Lin CY. Myocarditis after Covid-19 mRNA vaccination. N Engl J Med 2021; 385(14):1332-4.

Choi S, Lee S, Seo JW, Kim MJ, Jeon YH, Park JH, et al. Myocarditis-induced sudden death after BNT162b2 mRNA COVID-19 vaccination in Korea: case report focusing on histopathological findings. J Korean Med Sci [Internet]. 2021 (cited 2022 May 20);36(40):e286. Available from: doi:10.3346/jkms.2021.36.e286.

Chue KM, Kiat Tok NW, Gao Y. Spontaneous rare visceral pseudoaneurysm presenting with rupture after COVID-19 vaccination. ANZ J Surg 2022;92:915–7.

Tabata S, Hosoi H, Murata S, Takeda S, Mushino T, Sonoki T. Severe aplastic anemia after COVID-19 mRNA vaccination: Causality or coincidence? J Autoimmun 2022;126:102782.

Maiese A, Baronti A, Manetti AC, Paolo MD, Turillazzi E, Frati P, et al. Death after the Administration of COVID-19 Vaccines. Approved by EMA: Has a Causal RelationshipBeen Demonstrated? Vaccines 2022;10: 308.

Torjesen I. Covid-19: Pfizer-BioNTech vaccine is “likely” responsible for deaths of some elderly patients, Norwegian review finds. BMJ [Internet]. 2021 [cited 2022 May 20];373:n1372. Available from: http:// dx.doi.org/10.1136/bmj.n1372

Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36(42):2921–64.

Carubbi F, Alunno A, Leone S, Di Gregorio N, Mancini B, Viscido A, et al. Pericarditis after SARS-CoV-2 Infection: Another pebble in the mosaic of long COVID? Viruses 2021;13(10):1997.

Ling RR, Ramanathan K, Tan FC, Tai BC, Somani J, Fischer D , et al. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis. Lancet Resp Med 2022;10(7):679-88.

Dudley MZ, Halsey NA, Omer SB, Orenstein WA, O’Leary ST, Limaye RJ, et al. The state of vaccine safety science: systematic reviews of the evidence. Lancet Infect Dis 2020;20(5):e80-e89.

Tejtel SKS, Munoz FM, Al-Ammouri I, Conklin L, Savorgnan F, Guggilla RK, et al. Myocarditis and pericarditis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022;40(10):1499-511

Gargano JW, Wallace M, Hadler SC, Langley G, Su JR, Oster ME, et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization Practices—United States, June 2021. Morb Mortal Wkly Rep 2021;70(27):977-82.

Oster ME, Shay DK, Su JR. Myocarditis cases reported after mRNA-based COVID-19 vaccination in the US from December 2020 to August 2021. JAMA 2022;327(4):331-40.

Witberg G, Barda N, Hoss S, Ritcher I, Wiessman M, Aviv Y, et al. Myocarditis after Covid-19 vaccination in a large health care organization. N Engl J Med 2021; 385(23):2132-9.

Halushka MK, Vander Heide RS. Myocarditis is rare in covid-19 autopsies: cardiovascular finding across 277 post-mortem examinations. Cardiovasc Pathol 2021; 50:107300.

Fox SE, Li G, Akmatbekov A, Harbert JL, Lameira FS, Brown JQ. Unexpected features of cardiac pathology in COVID-19 Infection. Circulation 2020;142(11):1123– 5.

Giustino G, Croft LB, Oates CP, Rahman K, Lerakis S, Reddy VY, et al. Takotsubo cardiomyopathy in COVID-19. J Am Coll Cardiol 2020;76(5):628–9.

Bozkurt B, Kamat I, Hotez PJ. Myocarditis with COVID-19 mRNA Vaccines. Circulation 2021;144(6): 471-84.

Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol 2020;217:108480.

Heyman S, Cooper LT. Myocarditis after COVID-19 mRNA vaccination: clinical observations and potential mechanisms. Nat Rev Cardiol 2022;19(2):75–7.

Heymans S, Eriksson U, Lehtonen J, Cooper LT. Jr.The quest for new approaches in myocarditis and inflammatory cardiomyopathy. J Am Coll Cardiol 2016;68(21): 2348–64.

Porela P, Kyto V, Nikus K, Eskola M, Airaksinen KEJ. PR depression is useful in the differential diagnosis of myopericarditis and ST elevation myocardial infarction. Ann Noninvasive Electrocardiol 2012;17(2):141–5.

Brewster DC, Cronenwett JL, Hallett Jr JW, Johnston KW, Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 2003;37(5):1106-17.

Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician 2015;91(8):538-43.

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395(10234):1417-8.

Maccio U, Zinkernagel AS, Shambat SM, Zeng X, Cathomas G, Ruschitzka F, et al. SARS-CoV-2 leads to a small vessel endotheliitis in the heart. EBioMedicine 2021;63:103182.

Calabretta E, Moraleda JM, Iacobelli M, Jara R, Vlodavsky I, O’Gorman P. COVID-19-induced endotheliitis: emerging evidence and possible therapeutic strategies. British J Haematology 2021;193(1),43–51

Akgul A, Turkyilmaz S, Turkyilmaz G, Toz H. Acute aortic dissection surgery in a patient with COVID-19. Ann Thorac Surg 2021;111(1):e1-e3.

Engin M, Aydın U, Eskici H, Ata Y, Türk T. Type 1 acute aortic dissection in the early period after COVID-19 infection. Cureus 2021;13(3):e13751.

Ramandi A, Akbarzadeh MA, Khaheshi I, Khalilian MR. Aortic dissection and Covid-19; a comprehensive systematic review. Curr Probl Cardiol 2021;111(1): e1-e3.

Burkhardt A. Pathology of vaccine deaths and vaccine injuries: after the evidence now first proof [Internet]. [cited 2022 May 20]. Available from: https://pathologie-konferenz.de/en/

Brandes R, Fleming I, Busse R. Endothelial aging. Cardiovas Res 2005;66(2):286–94.

Makimattila S, Liu ML, Vakkilainen J, Schlenzka A, Lahdenpera S,Syvanne M, et al. Impaired endothelium-dependent vasodilation in type 2diabetes. Relation to LDL size, oxidized LDL, and antioxidants. Diabetes Care 1999;22(6):973–81.

Taddei S, Salvetti A. Endothelial dysfunction in essential hypertension: clinical implications. J Hypertens 2002; 20(9):1671–4.

Jonk AM, Houben AJ, Schaper NC, de Leeuw PW, Seme EH, Smulders YM, et al. Obesity is associated with impaired endothelial function in the postprandial state. Microvasc Res 2011;82(3):423-9.

Newby DE, Wright RA, Labinjoh C, Ludiam CA, Foxx KA, Boon NA, et al. Endothelial dysfunction, impaired endogenous fibrinolysis, and cigarette smoking: a mechanism for arterial thrombosis and myocardial infarction. Circulation 1999;99:1411–5.

Marin C, Ramirez R, Delgado-Lista J, Yubero-Serrano EM, Perez-Martinez P, Carracedo J, et al. Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium. Am J Clin Nutr 2011; 93(2):267-4.

Kondo T, Hayashi M, Takeshita K, Numaguchi Y, kobatashi K, Lino S, et al. Smoking cessation rapidly increases circulating progenitor cells in peripheral blood in chronic smokers. Arteriosclerosis, Thrombosis, and Vascular Biology 2004;24:1442–7.

Volaklis KA, Tokmakidis SP, Halle M. Acute and chronic effects of exercise on circulating endothelial progenitor cells in healthy and diseased patients. Clin ResCardiol 2013;102(4):249-57

Nagashima H, Endo M. Pitavastatin prevents postprandial endothelial dysfunction via reduction of the serum triglyceride level in obese male subjects. Heart and Vessels 2011; 26(4):428–34.

Rizza S, Cardellini M, Porzio O, Pecchioli C, Savo A, Cardolini I,et al. Pioglitazone improves endothelial and adipose tissue dysfunction in pre-diabetic CAD subjects. Atherosclerosis 2011;215(1):180–3.

Veerakul G. Endotheliitis after Covid-19 infection required optimization of chronic disease prevention. BKK Med 2020;10(1):147-53.

Li C, Chen Y, Zhao Y, Lung DC, Ye Z, Song W, et al. Intravenous injection of coronavirus disease 2019 (COVID-19) mRNA vaccine can induce acute myopericarditis in mouse model. Clin Infect Dis 2022; 74(11):1933-50.

Aretz HT, Billingham ME, Edwards WD, Factors SM, Fallon JT, Fenoglio Jr. JJ, et al. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1987;1(1):3–14.

Thomas CM, Mraz M, Rajcan L. Blood aspiration during IM injection. Clin Nurs Res 2016; 25(5):549–59.

Published

2022-10-25

How to Cite

วีรกุล ก., เชาน์ทวี เ., กฤดากร อ., & วัฒนศัพท์ ว. (2022). Myopericarditis and Acute Aortic Dissection after Receiving mRNA Based COVID 19 Vaccine: Cases Report and Literature Reviewed. Journal of Health Science of Thailand, 31(5), 945–960. Retrieved from https://thaidj.org/index.php/JHS/article/view/12795

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