Overview
Myopericarditis is a condition characterized by inflammation affecting both the myocardium and pericardium, often presenting with chest pain, electrocardiogram (ECG) abnormalities, and elevated cardiac biomarkers. It can arise from various triggers including viral infections, vaccinations, and bacterial infections 1234.Diagnosis
Clinical Presentation: Chest pain, often pleuritic in nature, with ECG changes and elevated cardiac enzymes 14.
Electrocardiogram (ECG): ST-segment elevation, T-wave inversions, or arrhythmias 13.
Echocardiography: Pericardial effusion, wall motion abnormalities, and occasionally regional wall motion abnormalities 13.
Cardiac Biomarkers: Elevated troponin I or T, creatine kinase (MB isoenzyme) 134.
Imaging: Chest X-ray or CT may show signs of pericardial effusion 1.
Pathology: Histopathological examination may confirm inflammation in both myocardium and pericardium 3.
Differential Diagnosis: Rule out acute coronary syndrome, myocarditis, and other causes of pericarditis 13.Management
Supportive Care: Rest, pain management (analgesics), and monitoring for complications 13.
Anti-inflammatory Therapy: Corticosteroids may be considered in severe cases or refractory symptoms (dose and duration vary; expert guidance recommended) 13.
Cardiac Monitoring: Continuous ECG monitoring, echocardiography for follow-up 13.
Close Observation: Regular assessment for signs of pericardial tamponade or arrhythmias 13.
Antibiotics: If bacterial etiology is identified (e.g., streptococcal tonsillitis), appropriate antibiotic therapy (e.g., penicillin) 4.
Vaccination Considerations: Evaluate risk-benefit ratio in post-vaccination cases, especially in adolescents 1.
Physical Activity Restriction: Avoid strenuous activity during acute phase and gradual reintroduction post-recovery 2.Special Populations
Adolescents: Higher incidence post-mRNA COVID-19 vaccination, particularly in males 1.
Athletes: Increased risk of sudden cardiac death during or after physical exertion, especially in males 2.
Pregnancy: Limited data; management should focus on supportive care and monitoring for complications [No specific data in provided abstracts].
Elderly: Less commonly reported but may present with atypical symptoms; careful evaluation necessary [No specific data in provided abstracts].
Comorbidities: Presence of pre-existing heart conditions may influence severity and management approach [No specific data in provided abstracts].Key Recommendations
Monitor Adolescents Post-Vaccination: Closely monitor adolescents, especially males, for symptoms of myopericarditis following mRNA COVID-19 vaccination (Evidence: Moderate) 1.
Consider Corticosteroids in Severe Cases: Use corticosteroids for severe or refractory myopericarditis (Evidence: Expert opinion) 13.
Restrict Physical Activity: Restrict strenuous physical activity in athletes diagnosed with myopericarditis until fully recovered (Evidence: Moderate) 2.
Evaluate for Bacterial Causes: In cases with suspected bacterial etiology, initiate appropriate antibiotic therapy (Evidence: Weak) 4.References
1 Guo BQ, Li HB, Yang LQ. Incidence of myopericarditis after mRNA COVID-19 vaccination: A meta-analysis with focus on adolescents aged 12-17 years. Vaccine 2023. link
2 Duraković Z, Misigoj Duraković M, Skavić J, Tomljenović A. Myopericarditis and sudden cardiac death due to physical exercise in male athletes. Collegium antropologicum 2008. link
3 Halsell JS, Riddle JR, Atwood JE, Gardner P, Shope R, Poland GA et al.. Myopericarditis following smallpox vaccination among vaccinia-naive US military personnel. JAMA 2003. link
4 Said SA, Severin WP. Acute nonrheumatic myopericarditis associated with group A hemolytic streptococcal tonsillitis in a male ICU-nurse. The Netherlands journal of medicine 1998. link00100-4)