Discussion:
Because of the most of the myopericarditis are asymptomatic, the
incidence and prevalence of this disease is not known exactly. But it is
suspected to be in the range of 1-10 cases per 100.000 persons and had a
variable autopsy prevalence(2–42%). The causes of myocarditis include
infectious and autoimmune etiologies(4).
In literatüre review in myocarditis cases after COVID-19 vaccination,
nearly all of them had high TI, most of them had abnormal ECG. Only a
half of them had abnormal echocardiographic findings. There were late
gadolinium enhancement and myocardial edema on cardiac MRI as a
suggestion for myocarditis on patients(1).
Although myopericarditis can be seen in the current immunization process
after many vaccines(3).
In recent studies, presented patients were male and aged between 14-19
years-old. All of the myopericarditis occured after second dose of
vaccine. And approximately 60% of myocarditis developed especially
after the Pfizer-BioNTech mRNA vaccine (5).
The mechanism of the COVID-19 vaccine associated myocarditis can be due
to cross-reaction between the antibodies against SARS-CoV-2 spike
glycoproteins and α-myosin(6).
CMR became the primary non-invasive test to assess the myocardial
inflammation in patients with suspected myocarditis (7).
SE is a technique of echocardiograhy which allows assessing left
ventricular contractility better than TE, especially in individuals with
normal systolic functions (8).
CMR and SE have been compared in the diagnosis and follow-up of
myocarditis in several studies, these studies presented the inflammation
detection as wall motion abnormalities are correlated between the SE and
CMR (9). According with this data, although CMR had a certain place for
the diagnosis and follow-up of myocarditis, we think that SE is an
effective method to diagnose and follow these patients in case of CMR
cannot accessible.
As in our case, Beata et al. prensented that myocarditis can
successfully diagnosed with SE(10). In our patient, similar data with
CMR and SE were obtained and these values in SE improved before
discharge. While it is a more practical and cost-effective on follow-up
with SE than CMR , also SE can be used for accuracy of diagnosis in
cases where CMR is not available.
Management of these patients vary due to the patient’s age as similiar
with non-vaccine myopericarditis; clinical
presentation-comorbidities-hemodynamic stability are importent for
patients’ management, Nonsteroidal anti-inflammators(NSAI), steroids,
colchicine are the main treatments .beta-blockers and
renin-angiotensin-aldosterone system inhibitors can use(6).