Relief of chest pain after SARS-CоV-2 vaccination

Abstract

A 46-year-old patient consulted a cardiologist complaining of discomfort behind the sternum, which manifested itself in 3 weeks after a mild COVID-19 recovery and had been persisting for about 4 months by the time she consulted the doctor. Echocardiography did not reveal any disturbances in regional and global contractility. It was thickening and hyperechogenicity of the pericardium of the lower-lateral, and lateral areas of the left ventricle without any signs of pathological exudation that attracted attention. A chest X-ray and a test with physical activity were performed. Blood tests did not reveal any abnormality, an increase in C-reactive protein was observed. The patient was diagnosed with chronic non-exudative form of pericarditis associated with COVID-19. A successful treatment was carried out: colchicine 0.5 mg/day, ibuprofen 600 mg 3 times a day. Next time the patient consulted a doctor 3 months later. Against the background of ARVI, typical episodes of low-intensity chest pain repullulated. Echocardiography showed regional exudation and initial signs of impaired diastolic function. A compulsory vaccination with Gam-COVID-Vac was carried out in 4 weeks. The post-vaccination period was accompanied by low-grade pyrexia for 2 days, after which the patient noted the complete disappearance of the heart pain. Echocardiography recorded pericardial layers separation and some improvement in diastolic function. The treatment was not carried out for various reasons. Over the next months, cardialgia did not recur. Check study 3 months after showed no visible exudation into the pericardial cavity, a decrease in hyperechogenicity compared to the records of previous studies was noted. In 8 months after vaccination, the patient suffered another mild COVID-19 with exudative pericarditis recurrence and the involvement of the pleura. Blood tests taken during the 1st week of the disease revealed a characteristic cellular shift (lymphocytosis 38%), as well as an increase in ERS up to 26 mm/h, D-dimer up to 1166 μg/l. CRP was normal. Additional analysis for cardiolipin antibodies, antinuclear factor, rheumatoid factor, cyclic citrullinated peptide antibodies, b2 glycoprotein I antibodies did not reveal any pathology. Transient low-grade pyrexia had been persisting for 3 weeks in evening hours, in spite of the fact that she kept taking 800 mg of ibuprofen per day. By now, the patient continues receiving colchicine according to the planned 6-months course of administration.