Leowattana Wattana, Leowattana Tawithep
Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand.
World J Cardiol. 2022 Jun 26;14(6):343-354. doi: 10.4330/wjc.v14.i6.343.
The coronavirus disease 2019 (COVID-19) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 infections has reduced the number of symptomatic patients globally. A case series of vaccine-related myocarditis or pericarditis has been published with extensive vaccination, most notably in teenagers and young adults. Men seem to be impacted more often, and symptoms commonly occur within 1 wk after immunization. The clinical course is mild in the majority of cases. Based on the evidence, a clinical framework to guide physicians to examine, analyze, identify, and report suspected and confirmed cardiac dysfunction cases is needed. A standardized workup for every patient with strongly suspicious symptoms associated with the COVID-19 mRNA vaccine comprises serum cardiac troponin measurement and a 12-lead electrocardiogram (ECG). For patients with unexplained elevation of cardiac troponin and pathologic ECG, echocardiography is recommended. Consultation with a cardiovascular expert and hospitalization should be considered in this group of patients. Treatment is primarily symptomatic and supportive. Deferring a 2 dose of the COVID-19 mRNA vaccination in individuals with suspected myocarditis or pericarditis after the 1 dose is suggested until further safety data become available.
针对严重急性呼吸综合征冠状病毒2感染的2019冠状病毒病（COVID-19）信使核糖核酸（mRNA）疫苗减少了全球有症状患者的数量。随着大规模接种疫苗，已发表了一系列与疫苗相关的心肌炎或心包炎病例，最显著的是在青少年和年轻人中。男性似乎更常受到影响，症状通常在免疫后1周内出现。大多数病例的临床病程较轻。基于现有证据，需要一个临床框架来指导医生检查、分析、识别和报告疑似和确诊的心脏功能障碍病例。对于每一位有与COVID-19 mRNA疫苗相关的强烈可疑症状的患者，标准化检查包括血清心肌肌钙蛋白检测和12导联心电图（ECG）。对于心肌肌钙蛋白不明原因升高且心电图异常的患者，建议进行超声心动图检查。对于这类患者，应考虑咨询心血管专家并住院治疗。治疗主要是对症和支持治疗。建议在接种第1剂后疑似心肌炎或心包炎的个体中推迟接种第2剂COVID-19 mRNA疫苗，直到获得更多安全性数据。
