Myocarditis From COVID: Fact or Fiction?

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Here, in the United States, the first documented cases of COVID-19 were as early as December 2019. Then came the shutdown of our nation 3 months later in March of 2020. The virus, which is the cause of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for countless numbers of deaths and other health complications. One major area of damage in those who have overcome their illness, is possible cardiac damage- more specifically, myocarditis. This article explains what researchers today say about this topic and may help answer the question of whether or not you can get myocarditis from COVID-19.

What is Myocarditis?

In simple terms, myocarditis is inflammation of the heart muscle (myocardium).

Causes and Symptoms of Myocarditis

The most common cause of myocarditis is through a viral infection. Overall, it is rare, however a diagnosis may include symptoms such as:

  • Chest pain
  • Fatigue
  • Dizziness
  • Abnormal heartbeat or palpitations
  • Shortness of breath
  • Swelling in your extremities (ankles, feet, or hands)

Treatment of Myocarditis

In mild cases, you can recover from myocarditis without medical treatment. Although in more severe cases, including the symptoms above, you may need medical treatment at a hospital.

More specifically, you may need several medications to help relax your blood vessels, lower your blood pressure, slow your heart rate, get rid of excess fluid from your body, or control your heart rhythm.

In addition, if excess fluid is causing your extremities to blow up like a balloon, it is best to limit sodium intake to 2,000 mg per day.

>>For some easy-to-understand handouts on how to reduce sodium intake, see my “Sodium: How Much is Too Much?” handout or my “Salt Substitute Guide” handout.

The COVID-Cardiac Link

Okay, let’s get into the nitty gritty on answering the question of whether you are more likely to get myocarditis from COVID-19 infection or not. So far, there a few things we KNOW as truth:

  • The most common cause of myocarditis is viral infection.
  • COVID-19 is a viral infection.
  • COVID-19 causes inflammation within our body.
  • Inflammation plays a large role in developing myocarditis.

Oleszak et al. explains that, “in patients with COVID-19, viral myocarditis is an important cause of myocardial injury”. But also that “the exact mechanisms of cardiac injury in COVID-19 are not well established.”

We also know that COVID-19 mainly effects the respiratory system. This includes your airway, lungs and blood vessels.

Based off of the information we know as truth, it is no surprise that heart complications may also result from a COVID-19 infection. Some of these heart issues include:

  • heart attack and myocarditis
  • cardiac fibrosis – abnormal thickening of heart valves
  • arrhythmias – abnormal heartbeats
  • endothelial dysfunction – narrowing of your heart’s blood vessels, restricting blood flow
  • dysautonomia – dysfunction of the autonomic nervous system (ANS)
  • and cardiac events involving blood clots

Current Statistics

As of April 26th, 2022, when I am posting this article, there have been 80,874,929 total cases reported and 988,991 total deaths related to COVID-19.

To access this data, you can visit the COVID Data Tracker, available through the CDC website. Here, you can view updated stats on the total number of COVID-19 cases, deaths, hospitalization and immunizations.

Cases of Myocarditis

Of all the total cases of COVID-19 reported, there is no public database that shows how many of these cases are linked to myocarditis.

However, the American Heart Association does have a COVID-19 Cardiovascular Disease Registry. This registry is in place to understand patterns and variations of clinical treatment in hospitalized COVID-19 patients. The data collected will help future research on COVID-19, develop treatment protocols, and identify risk factors related to cardiovascular health.

Unfortunately, only a small fraction of hospitals participate in using the AHA’s registry. Additionally, the registry uses specific inclusion criteria that excludes patients outside of a hospital setting and those under the age of 18 years.

Therefore, there is no way to truly uncover the number of cases of myocarditis that have resulted from COVID-19 infection.

Cases of Myocarditis Following COVID-19 Diagnosis

One set of facts available is hospital inpatient data showing a rise in cases of myocarditis that coincides with the rise in COVID-19 inpatient cases.

A major report shows that for those diagnosed with myocarditis, ~42% had a history of COVID-19. The majority of these people (~90%) were diagnosed with COVID-19 and myocarditis during the same month. The remaining ~10% were diagnosed with myocarditis within a few months following their COVID-19 diagnosis.

Who is at Highest Risk for Myocarditis?

The research does show some clear high risk populations when it comes to myocarditis diagnoses and COVID-19.

Of the most current research today, those at highest risk for developing COVID-19 include:

  • Males
  • Children <16 years old
  • Adults >50 years old and older
  • African Americans
  • Those with specific underlying medical conditions

Similarly, the Myocarditis Foundation mentions that although cardiovascular events often affect the elderly population, myocarditis can affect anyone.

In fact, it most often affects otherwise healthy, young, athletic types. The highest risk age range are those from puberty through the early 30’s. The Myocarditis Foundation also states that males are affected twice as often as females.

Therefore, from the information above, we can conclude that the highest risk population of those both with and without COVID-19 are primarily young males.

This picture depicts the hospitalized population at highest risk for developing myocarditis.

Should I Be Worried About Getting Myocarditis?

As mentioned earlier, myocarditis is a rare condition. Likewise, having COVID-19 and myocarditis simultaneously, is also rare. But are you more likely to get myocarditis if you’ve been vaccinated?

There are currently three vaccines available to protect against COVID-19 infection:

  1. Pfizer-BioNTech COVID-19 Vaccine (Comirnaty®) – FDA-approved for people ages 16 years and older; also for emergency use in people ages 5 years and older.
  2. Moderna COVID-19 Vaccine (Spikevax®) – FDA-approved for people ages 18 years and older.
  3. Johnson & Johnson’s Janssen COVID-19 Vaccine – authorized for emergency use in people ages 18 years and older.

If You are Vaccinated

In 2021, following the implementation of COVID-19 vaccination efforts, there have been higher numbers of people diagnosed with myocarditis and pericarditis in the United States. This is seen more from mRNA COVID-19 vaccinations (Pfizer-BioNTech and Moderna), particularly in adolescents and young adults. These findings were not reported however with the Johnson & Johnson vaccine.

There is even a term, called vaccine-associated myocarditis (VAM) to describe the condition. VAM is more common among adolescent and young males between the ages of 12 and 24 years old.

The CDC estimates the VAM rate to be 32.4 cases per every million cases for all doses and 66.7 per million after the second dose of mRNA vaccine. The symptoms and course progression of VAM however, are quite mild; requiring simple treatment of anti-inflammatory drugs.

It’s important to note that cases occur more often following the second dose of the vaccine versus the first dose. And onset of symptoms is usually within several days after the mRNA COVID-19 vaccination.

So, you can see that there is, indeed, a risk. Even if only a small risk.

What About Booster Shots?

Just like mRNA vaccines, mRNA boosters are 82% effective against urgent care and emergency department visits and 90% effective against hospitalization. So, although some people may experience side effects or symptoms from vaccines and boosters, the benefit outweighs the risk.

If You are Unvaccinated

Unvaccinated individuals who develop myocarditis are not as lucky. We’ll refer to these cases as COVID-associated myocarditis.

In these cases, you’re more likely to have complicated and severe symptoms compared to those who have gotten the vaccine. No vaccine may also mean possible ventilator support in a critical care unit if symptoms are severe enough.

As far as the numbers show, COVID-associated myocarditis is likely greater than vaccine-associated myocarditis as well. Although VAM does exceed COVID-associated myocarditis for teen males.

How to Protect Yourself

You can protect yourself and those around you by:

  • following recommendations of health experts and scientists
  • getting fully vaccinated against the COVID-19 virus, including boosters when available
  • continuing to wear masks in crowded places
  • keeping a safe distance (at least 6 feet) between you and others in public areas

Healthcare systems are also providing ongoing data in order to protect the public. Health professionals all over the country continue to report all cases of myocarditis and pericarditis that occur following COVID-19 vaccination. This is by way of the Vaccine Adverse Event Reporting System (VAERS).

Conclusion

Overall, getting a vaccine in order to reduce the number of COVID-19 cases and complications is still the recommendation. The majority of current research agrees that the risks outweigh the benefits.

Even though the risk of getting myocarditis for both vaccinated and unvaccinated individuals is very low, unvaccinated individuals are more likely to have more severe symptoms, longer hospital stays, and possible need for intensive care and advanced life support.

In contrast, those who develop myocarditis following vaccination have a generally mild course.

And finally, now that vaccines are available for teens, particularly the high risk male population, I’d say it’s better to be safe than sorry.

Of course, more research is in progress. We will continue to monitor trends, document and analyze data, develop statistics, etc. And hopefully someday soon, the COVID-associated myocarditis will no longer be something our future population will experience.

References:

  1. Boehmer TK, Kompaniyets L, Lavery AM, et al. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021. MMWR Morb Mortal Wkly Rep 2021;70:1228–1232. Accessed March 24, 2022. Available at: DOI: http://dx.doi.org/10.15585/mmwr.mm7035e5external icon
  2. Oleszak F, Maryniak A, Botti E, et al. Myocarditis Associated With COVID-19. American Journal of Medicine Case Report. 2020;8(12):498-502. Accessed: March 24, 2022. Available at: https://pubmed.ncbi.nlm.nih.gov/33088905/
  3. NORD (National Organization for Rare Disorders). Myocarditis. Published: June 9, 2015. Accessed: April 7, 2022. Available at: https://rarediseases.org/rare-diseases/myocarditis/
  4. American Heart Association. Covid-19 CVD registry. Accessed: April 17, 2022. Available at: https://www.heart.org/en/professional/quality-improvement/covid-19-cvd-registry
  5. CDC COVID Data Tracker. Centers for Disease Control and Prevention. Published March 28, 2020. https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance.
  6. Myocarditis Foundation. About Myocarditis. Accessed: April 17, 2022. Available at: https://www.myocarditisfoundation.org/about-myocarditis/
  7. Stecker, E, Mullen B. Vaccine-Associated Myocarditis Risk in Context: Emerging Evidence. American College of Cardiology. Published February 9, 2022. Accessed: April 26, 2022. Available at: https://www.acc.org/latest-in-cardiology/articles/2022/02/09/12/56/vaccine-associated-myocarditis-risk-in-context

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