The Centers for Disease Control and Prevention (CDC) has released clinical recommendations for the management of myocarditis and pericarditis, inflammation of the heart, in vaccinated individuals following news that the agency was investigating a small number of young adults and adolescents who may have experienced heart problems following a COVID-19 vaccination. There is no clear link to the vaccine at this time.
The CDC said growing reports of heart issues have cropped up after mRNA COVID-19 vaccination (Pfizer, Moderna) since April, especially in male adolescents and young adults aged 16 and older. Such a pattern has not been observed in those who received Johnson & Johnson’s single-dose vaccine.
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In most cases, patients quickly improved after treatment and rest. Symptoms usually started within several days of vaccination, and more frequently occurred after the second dose. It is not yet clear exactly how many reports have cropped up, and a CDC spokesperson declined to release a number when prompted earlier this week. The spokesperson said the number of reported cases is “rare given the number of vaccine doses administered.”
“CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the risk of COVID-19 illness and related, possibly severe complications, such as long-term health problems, hospitalization, and even death,” the agency wrote.
The CDC advised reporting all such cases of heart issues post-vaccination to the country’s surveillance system, VAERS. The agency recommended that the clinicians look for symptoms like chest pain, shortness of breath and palpitation, and consider myocarditis and pericarditis as a cause, while also ruling out other causes behind heart inflammation.
“In this younger population, coronary events are less likely to be a source of these symptoms,” the agency said.
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If the patient is presenting symptoms, clinicians should ask about COVID-19 vaccination status, and relevant medical, travel and social history, the CDC advised.
“For initial evaluation, consider an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely,” the guidance reads. “For suspected cases, consider consultation with cardiology for assistance with cardiac evaluation and management. Evaluation and management may vary depending on the patient age, clinical presentation, potential causes, or practice preference of the provider.”
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During follow-up with patients experiencing myocarditis, clinicians were advised to use guidance from the American Heart Association and the American College of Cardiology.