SHM Converge Scientific Abstract ePoster Gallery-A Case of Atypical Acute Pericarditis Post Mrna Vaccination Presenting as Stemi

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This poster describes a 45-year-old woman who developed atypical acute pericarditis shortly after receiving the Pfizer-BioNTech mRNA COVID-19 vaccine. Her chest pain began 48–72 hours after the first dose, worsened after the second dose three weeks later, and was sharp, positional, pleuritic, and radiated to the left arm, neck, and back. She had a prior history of pulmonary embolism but was not on anticoagulation.<br /><br />On presentation, her vitals were stable, but exam revealed a pericardial friction rub. Her EKG showed inferior ST-segment elevations, which initially raised concern for STEMI. However, urgent coronary angiography showed no thrombus or coronary abnormality, troponin and myoglobin were not elevated, and CT angiography was negative for pulmonary embolism. Further evaluation supported acute pericarditis: CRP and ESR were elevated, echocardiography showed a small pericardial effusion with thickened pericardium, and left ventricular function was normal.<br /><br />She improved significantly with high-dose ibuprofen and colchicine.<br /><br />The discussion emphasizes that COVID-19 vaccines are generally safe and effective at reducing hospitalization and death, though rare adverse events such as myocarditis, pericarditis, thrombosis, capillary leak syndrome, and Guillain-Barré syndrome have been reported. Most vaccine-associated pericarditis/myocarditis cases occur in male adolescents and often after the second dose. In this case, the lack of classic diffuse pericarditis EKG findings led to an initial misdiagnosis of STEMI, highlighting the importance of considering pericarditis in patients with pleuritic, positional chest pain and supportive inflammatory findings after vaccination.

Asset Subtitle

Shivaraj Nagalli

Meta Tag

Author List Shivaraj Nagalli

Category Clinical Vignettes

Concept COVID-19 vaccination

Concept Pericarditis

Concept Effectiveness

Concept Pericardial Friction Rub

Concept ST Elevation

Distinguished Non-Finalist

Presenter Organization Brookwood Baptist Health

Presenting Author Shivaraj Nagalli

Track Adult

Keywords

acute pericarditis

Pfizer-BioNTech mRNA vaccine

COVID-19 vaccination

chest pain

ST-segment elevation

coronary angiography

pericardial effusion

colchicine

ibuprofen

myocarditis

COVID-19 vaccination

Pericarditis

Effectiveness

Pericardial Friction Rub

ST Elevation