पृष्ठभूमि
Myocarditis and pericarditis are rare but serious cardiac conditions. Myocarditis involves inflammation of the myocardium (the middle muscular layer of the heart wall). Pericarditis involves inflammation of the pericardium (the sac surrounding the heart). They can occur separately or together (myopericarditis). Complications of these conditions can include irregular heartbeat (arrhythmia), and/or enlargement and weakening of the heart – both of which can impair the ability to pump blood effectively.
Myocarditis and pericarditis can be inherited conditions, or can be caused by infections (such as influenza and COVID19), injury, taking certain medications (including illicit drugs) and autoimmune diseases. A small number of cases have been reported following receipt of some vaccines (COVID19 और mpox).
डीiagnosis
Myocarditis and pericarditis present with a similar range of symptoms. In cases following vaccination, myocarditis symptoms have typically presented within 2 to 7 days, and pericarditis symptoms can occur within 2 to 3 weeks. Individuals may notice:
- chest pain, pressure or discomfort
- pain with breathing (pleuritic chest pain)
- सांस लेने में कठिनाई
- धड़कन
- syncope (faint)
- other non-specific symptoms such as fatigue, dizziness, abdominal pain.
imely medical review by a GP or through a hospital emergency department है important. Investigations to support diagnosis might include blood tests (for cardiac biomarkers, e.g. troponin), ECG और imaginजी (e.g. chest Xray, cardiac MRI, ultrasound, echocardiogram).
Association and incidence
Myocarditis, from any cause, occurs more commonly in males than females. It is also more likely to affect younger adults, compared with children or older adults.
Pericarditis, from any cause, occurs in similar rates among males and females. It is more likely to affect adults, compared with children.
COVID19 vaccination
Most cases of COVID19 टीकाassociated myocarditis and/or pericarditis were reported following receipt of a second dose of mRNA vaccine. However, they have been reported following any dose and any type of COVID19 vaccine.
Local and international data shows that pericarditis following COVID19 vaccination is more common in the 18- to 39yearold age group for both males and females. आरates of myocarditis occurring following COVID19 vaccination vary; however, they are above expected background rates for both sexes. The peak risk group for COVID19 vaccine related myocarditis is young adult males aged 16 to 17 years, with a smaller increased risk for males aged between 12 to 24 years.
Mpox vaccination
Myocarditis and/or pericarditis have been associated with administration of वांe smallpox vaccine ACAM2000, occurring at a rate of approximately 1 in 175 adults who receive the vaccine for the first time. ए very small number of cases of myocarditis and/or pericarditis have been reported following receipt of जैनियोस (MVA-BN), with no causal relationship established with this टीका.
इलाज
एमyocarditis and/or pericarditis (including arrhythmias, decreased cardiac function, congestive cardiac failure) are managed by a cardiologist. Treatment may include in-patient monitoring and pharmacological agents such as ACE-inhibitors and beta-blockers.
Longterm followup of individuals who have experienced myocarditis and/or pericarditis following COVID-19 vaccines continues to be evaluated to determine longterm prognosis and impact. One of the key, long-term follow-up issues post-myocarditis is late gadolinium enhancement (LGE) seen on cardiac MRI, indicating heart scarring and a risk of future arrhythmias. LGE can occur following both infection and vaccination, so longer term follow-up remains important.
भविष्य की खुराक के लिए निहितार्थ
All episodes of myocarditis and/or pericarditis occurring following vaccination should be reported to the adverse event reporting service in your jurisdiction.
COVID-19 टीकाकरण
Further vaccination should be withheld until review by a specialist immunisation service if the individual has experienced:
- suspected myocarditis following COVID-19 vaccination (with no clear alternate diagnosis)
- suspected pericarditis following COVID-19 vaccination with abnormal investigations (and no clear alternate diagnosis)
- suspected pericarditis where investigations were unable to be performed/unavailable (in those aged 39 years or younger).
Mpox vaccination
Individuals who have been diagnosed with myocarditis and/or pericarditis following mpox vaccination should be referred to a specialist immunisation service for follow–up and advice on future doses.
एहतियात
If both COVID-19 and mpox vaccination are recommended and the timing is not urgent, an interval of 4 weeks is recommended to minimise the risk for developing myocarditis and/or pericarditis.
However, if mpox primary preventative vaccination (PPV) or post-exposure preventative vaccination (PEPV) is urgent, it should not be delayed or withheld in individuals who recently received a COVID–19 vaccine.
संसाधन
- Sexson Tejtel SK, Munoz FM, Al-Ammouri I, et al. Myocarditis and pericarditis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. टीका. 2022;40(10):1499-1511. doi:10.1016/j.vaccine.2021.11.074
- ATAGI: COVID-19 vaccination – Guidance on myocarditis and pericarditis after COVID-19 vaccines
- MVEC: Mpox
- एमवीईसी: कोविड-19
लेखक: Rachael McGuire (MVEC Education Nurse Coordinator), Francesca Machingaifa (MVEC Education Nurse Coordinator), Daryl Cheng (MVEC Medical Lead) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)
द्वारा समीक्षित: राचेल मैकगुइर (एमवीईसी शिक्षा नर्स समन्वयक) and Nigel Crawford (Director, Melbourne Vaccine Education Centre)
तारीख: November 2024
नई जानकारी और टीके उपलब्ध होते ही इस अनुभाग की सामग्रियों को अद्यतन किया जाता है। मेलबर्न वैक्सीन एजुकेशन सेंटर (MVEC) कर्मचारी सटीकता के लिए नियमित रूप से सामग्रियों की समीक्षा करते हैं।
You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.