A Review of Cardiac ComplicationsAssociated With COVID-19 and ItsVaccination

Abstract

This review comprehensively examines cardiovascular complications associated with coronavirus disease 2019
(COVID-19) infection and its vaccination, focusing on myocarditis, pericarditis, and other cardiovascular adverse
events. We synthesize data from epidemiological investigations, clinical case reports, and global health databases
(e.g., World Health Organization, Centres for Disease Control) to assess the prevalence, mechanisms, and clinical
outcomes of cardiac injury in hospitalized COVID-19 patients and vaccinated individuals. Acute myocardial
injury was observed in 6.9–36% of hospitalized patients, with elevated cardiac troponin levels and left ventricular
dysfunction being common; these patients exhibited higher mortality rates and complications such as acute
respiratory distress syndrome. Moreover, rare but significant cardiovascular events, particularly myocarditis, were
reported post-vaccination, with an incidence of ~1 in 20,000 in young males, often presenting with chest pain and
fever within 2–3 days. Cardiac magnetic resonance imaging findings supported these diagnoses, though biopsy
results were occasionally inconclusive. The proposed mechanisms for vaccine-induced myocarditis involve
immune-mediated responses and spike protein interactions with angiotensin-converting enzyme 2 receptors,
while management strategies include corticosteroids and non-steroidal anti-inflammatory drugs, with most cases
resolving without long-term sequelae. This review addresses the vaccine hesitancy and emphasises the need for
further research to clarify relationships and optimize patient care.