Cardiovascular disorders after the third dose of COVID-19 vaccine
Most cases of cardiovascular adverse events in vaccine recipients occur following the second dose. Cases following the third dose of COVID-19 vaccines have been also reported. The risk was about the same as after the 2nd dose. We discussed a fatal case of a 26-year-old male who did not have any side effects from his two previous doses. Here are two similar cases with subsequent resolution.
A 43-year-old female with no past medical history presented with palpitations and shortness of breath started 2 days after receiving the third dose of BNT162b2 COVID-19 vaccine. No side effects of the vaccine were noted following the preceding two doses received five months prior. On presentation, her electrocardiogram showed rapid monomorphic ventricular tachycardia (VT) requiring a synchronized cardioversion (see Figure).
Laboratory blood tests showed normal complete blood count, elevated C-reactive protein up to 6.7 mg/dl, and high-sensitive troponin I up to 2082 ng/L. D-dimer was also elevated at 1.3 ng/L, but a Chest CT angiography ruled out acute pulmonary embolism. Polymerase-chain-reaction (PCR) tests of nasopharyngeal swab obtained on admission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and for other viruses causing upper respiratory tract infection was negative.
The patient was treated with prednisone (1 mg/kg, with gradual dose tapering over the next 3 months), bisoprolol, and ramipril, with complete resolution of symptoms, inflammatory markers, and troponin elevation. Her LV systolic function remained mildly to moderately reduced, and given her presentation with life-threatening arrhythmia, the patient was discharged home with a wearable defibrillator (LifeVest) while on steroid therapy.
A 62-year-old woman diagnosed in September 2019 of lung adenocarcinoma
with permanent ventricular stimulation. After device inhibition, complete AV block was confirmed and, 2 weeks later, conduction was restored once more.sinus rhythm
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