Circulation: Myocarditis related to COVID-19 shots in teen agers and young adults

Circulation, a well-respected medical journal widely read by internists and cardiologists,  published a study showing a temporal relationship between COVID-19 shots and myocarditis in teenagers and young adults.

The authors used the criteria set by the  Centers for Disease Control and Prevention to diagnose myocarditis.

Study Findings

White Males developed the most myocarditis

The study showed 139 adolescents and young adults with 140 episodes of suspected myocarditis. Most patients were male (90.6%) and White (66.2%).  20.9% were Hispanic.

The median age was 15.8 years (range 12.1-20.3).

Myocarditis happened the most after the mRNA shots 

After the mRNA vaccine, myocarditis occurred in 97.8%. 94.2% of them follow the Pfizer-BioNTech vaccine, with 91.4% after the 2nd dose.

Myocarditis symptoms start within days.

Symptoms started a median of 2 days (range 0-22) after vaccination. The most common symptom was chest pain (99.3%).

Clinical features of the myocarditis cases

The median hospital stay was two days (range 0-10). All patients had elevated troponin. Elevated troponin levels are indicative of heart muscle injury.

Dangerous Heart Rhythms

69.8% had abnormal electrocardiograms or arrythmias (7 with non-sustained ventricular tachycardia).

The EKG tracings below show a normal heart rhythm above and a ventricular tachycardia rhythm below it.

By BruceBlaus from Wikipedia

Ventricular tachycardia (VT) is an abnormal rhythm. If you are in a hospital and your heart monitor shows VT, I can guarantee you that a nurse or doctor will be beside you right away. Non-sustained VT lasts shorter than 30 seconds and is not fatal.

However, if the VT lasts longer than 30 seconds and you have symptoms like altered level of consciousness, chest pain, or shortness of breath, the doctor will apply an electric shock thru paddles on your chest. It feels like a horse kicked you on the chest, but it is better than the alternative — death.

Decreased ejection fractions

The ejection fraction measures the ability of the heart to pump blood. A normal ejection fraction is between 50-70%.  In the study, 18.7% had left ventricular ejection fraction (LVEF) <55% on echocardiogram.

Cardiac Magnetic Resonance Imaging findings

Cardiac MRI is the definitive test to show inflammation of the heart muscles. Ninety-seven patients underwent cMRI at a median of 5 days (range 0-88) from symptom onset.

77.3% had abnormal findings: 74 (76.3%) had late gadolinium enhancement. Radiopaedia defines late gadolinium enhancement as a technique used in cardiac MRI to assess heart muscle scar formation and regional myocardial fibrosis

54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria for myocarditis.  Radiologists use the Lake Louis Criteria when reading cardiac MRIs to establish myocarditis.

The good news is that all with follow-up had normalized heart function. However, the findings in the second study are different.

The Rose and McCullough Study

The journal, Current Problems in Cardiology initially accepted the peer-reviewed research, A Report on Myocarditis Adverse Events in the U.S. Vaccine Adverse Events Reporting System (VAERS) in Association with COVID-19 Injectable Biological Products.

However, at the last minute, the journal did not publish it. Can you guess why?

The authors Jessica Rose and Dr. Peter McCullogh found that myocarditis among the vaccinated happened 19 times over the expected background myocarditis rates for the 13-23 year age group.

In addition, there is a 5-fold increase in myocarditis rate after the second dose as opposed to dose 1 in 15-year-old males.  Of the total myocarditis adverse event reports, six individuals died (1.1%), and of these, two were under 20 years of age.

Yesterday, the Daily Mail reported a 26-year old male from New Zealand died of myocarditis. He died within two weeks after receiving the first dose of the Pfizer COVID-19 shot. He is the second person to die of vaccine-induced myocarditis in New Zealand.

My take

Whenever a patient talks to a doctor about their medical problem, physicians ask about the events before symptoms start. That is done to establish a cause-and-effect relationship. From the patient’s history, a recommendation is made.

If condition X (myocarditis) frequently after event Y (COVID shots), we tell the patient not to do Y anymore. Not only that, physicians should tell everybody else not to get vaccinated anymore.

COVID-19 in children 0-17 years old have a low risk of death and hospitalization

 

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References:

  1. Truong et al. Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults. Circulation. Dec 6,  2021, https://doi.org/10.1161/CIRCULATIONAHA.121.056583.
  2. : Jessica Rose Ph.D., MSc, BSc, Peter A. McCullough MD, MPH, A Report on Myocarditis Adverse Events in the U.S. Vaccine Adverse Events Reporting System (VAERS) in Association with COVID-19 Injectable Biological Products, Current Problems in Cardiology (2021), doi: https://doi.org/10.1016/j.cpcardiol.2021.101011

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