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On Call: Heart Issues After Vaccination

Thu, 07/22/2021 - 08:00

Recently, there have been reports of increased incidence of myocarditis — inflammation of the muscle of the heart — and pericarditis — inflammation of the lining surrounding the heart — after vaccination with one of the messenger RNA vaccines against Covid-19. There appears to be a relationship between the vaccinations and the increased incidence, although myocarditis and pericarditis both occur in other circumstances as well, including sometimes after viral illnesses.

Pericarditis generally occurs in younger patients as opposed to older ones, a result of the body's immune system reacting to some infection or trigger generally; in this case, possibly the mRNA vaccines. Symptoms can include chest pain, shortness of breath, and sometimes palpitations. Treatment for it is generally supportive while people recover, and may include exercise restrictions until people fully recover.

According to the Centers for Disease Control, cases have generally occurred in young adolescents and adults older than 16, mostly in males, and usually symptoms have occurred within a few days of vaccination (generally the second dose). The C.D.C. reports that as of July 12 there have been 1,047 cases of myocarditis or pericarditis reported in adults under the age of 30. Some of these people have had to be hospitalized, but no deaths have been reported, and in the United States data as well as published data out of Israel, the vast majority of these patients appeared to have recovered fully.

Understandably, these reports have concerned many people, particularly parents of adolescents who have been urged otherwise to strongly consider vaccination. The C.D.C. and the World Health Organization, along with all major professional medical and public health organizations, continue to intensely advocate for vaccination despite these reports. One reason for this is because they remain exceedingly rare; consider that for those little over 1,000 cases, over 177 million people in the United States have received at least one dose of a vaccination against Covid-19. Clearly, while this adverse effect of myocarditis and/or pericarditis is not trivial and deserves continued research and exploration, it represents a very, very rare event.

Moreover, the excellent recovery reported among patients who have contracted myocarditis or pericarditis after Covid vaccination is also very heartening, particularly as so many people who have contracted Covid-19 continue to struggle with symptoms. As the Delta variant continues to spread across the country, it becomes more vital than ever to effectively utilize the tools we have available to limit significant illness and death, and vaccination remains one of if not the greatest tools we have with which to do this, particularly as unvaccinated individuals continue to represent the overwhelming majority (over 99 percent in several published reports) of deaths from Covid-19 in recent weeks.

Does this mean that if you experience chest pain, shortness of breath, and/or palpitations in the days after vaccination, the symptoms should be minimized or ignored? Absolutely not. If you or a loved one, particularly an adolescent or young adult under 30, develops these symptoms after vaccination against Covid-19, especially after one of the mRNA vaccines such as the Pfizer or Moderna shots, you should contact your primary care provider immediately to discuss next steps.

If the symptoms are severe and/or you cannot reach your primary care provider, you should consider going to your nearest emergency room more promptly for evaluation, but you can rest assured knowing this is very unlikely to occur given the rare incidence of this adverse effect to date as well as the excellent prognosis for recovery, something we very often cannot say when someone is infected with Covid-19. Yes, adolescents and young adults are often fortunate generally not to become very ill or suffer severe morbidity or die from Covid-19, but during the infectious period they can continue to spread the virus, endangering those around them. In the end, the statistics and science continue overwhelmingly to support vaccination in all eligible groups as soon as possible so that we can end this pandemic once and for all.

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