SHM Converge Scientific Abstract ePoster Gallery-A Chest Pain Challenge

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A previously healthy 32-year-old man presented with acute chest pressure radiating to the back and jaw, improved by leaning forward, along with fatigue, myalgias, and headache. Symptoms began three days after his third COVID-19 vaccine dose (Pfizer-BioNTech) and six months after completing an initial AstraZeneca series. He had a prior COVID-19 infection 1.5 years earlier without cardiac complications.<br /><br />On evaluation, he was hemodynamically stable but hypertensive. High-sensitivity troponin was markedly elevated and rose further. ECG showed diffuse ST-segment elevations. Transthoracic echocardiogram was normal, with no pericardial effusion. Cardiac MRI demonstrated subepicardial enhancement in the mid-apical and lateral walls, confirming myocarditis.<br /><br />He was treated with ibuprofen and colchicine and discharged after three symptom-free days, with plans to continue therapy for three months. At two-week follow-up, he remained asymptomatic. His inflammatory marker, C-reactive protein, normalized from 4.3 during hospitalization to 0.5, and he was advised to resume normal activity.<br /><br />The discussion emphasized that myocarditis is a rare but important adverse event after mRNA COVID-19 vaccination, occurring more often after the second dose and typically within 2–3 days of vaccination. It is most common in males aged 12–24, but this case shows it can also occur in adults. Most patients have normal echocardiograms, while cardiac MRI is the most sensitive noninvasive test, showing myocardial edema and late gadolinium enhancement. Overall prognosis is usually favorable, with rapid symptom resolution, and normalization of biomarkers such as CRP may help guide safe return to exercise.

Asset Subtitle

Grace Alexander

Meta Tag

Author List Grace Alexander, Katherine I. Harris, Paul Lindower, Ruchi Sharma

Category Clinical Vignettes

Concept COVID-19 Vaccine-Associated Myocarditis

Concept Myocarditis

Concept mRNA Vaccination

Concept Troponin

Concept Cardiac MRI

Distinguished Non-Finalist

Presenter Organization University of Iowa Hospital & Clinics

Presenting Author Grace Alexander

Track Adult

Keywords

myocarditis

COVID-19 vaccination

mRNA vaccine

chest pain

troponin elevation

diffuse ST elevation

cardiac MRI

late gadolinium enhancement

colchicine

C-reactive protein

COVID-19 Vaccine-Associated Myocarditis

Myocarditis

mRNA Vaccination

Troponin

Cardiac MRI