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Understanding Risk of Myocarditis

Today's episode of Kids Health Cast comes from our Back to Health series. This conversation features Dr. Maria Karas and we discuss what expecting patients should know about Myocarditis and parents' concerns around the COVID-19 vaccine for their kids. She shares the symptoms and causes of the inflammation of the heart. She also addresses the links to COVID-19 and concerns around the COVID-19 vaccination. She also highlights steps to prevention for the viral infections.

To schedule with Dr. Maria Karas
Understanding Risk of Myocarditis
Featured Speaker:
Maria Karas, MD
Dr. Karas was raised in Wilmington, DE and received her undergraduate education at the University of Pennsylvania. She received her medical degree from Weill Medical College of Cornell University in 2006. 

Learn more about Maria Karas, MD

Melanie Cole (Host): Today's episode of Kids Health Cast comes from our Back to Health series. This conversation features Dr. Maria Karas and we discuss what patients should know about Myocarditis and parents' concerns around the COVID-19 vaccine for their kids. Dr Maria Karas is an Assistant Professor of Medicine in Advanced Heart Failure and Pulmonary Hypertension; and she’s the Medical Director, Cardiac Intensive Care Unit at Weill Cornell Medicine Back to Health features conversations about trending health topics, and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I am Melanie Cole Dr. Karas, it's a pleasure to have you with us. Most people and many people before recently had not heard of myocarditis. And now all of a sudden we hear about it in the news a little bit. Tell us a little bit about what it is and really how common is it?

Maria Karas, MD (Guest): Thanks for inviting me to speak about this. So, myocarditis really is a general term for inflammation in the heart. And what that means more specifically, is that there are inflammatory cells, that are actually invading into the heart muscle. And ultimately what can happen is, heart muscles can be damaged and they can actually die. And patients can develop things like heart dysfunction and arrhythmias as a result of this.

Host: Well, thank you for that good definition. Make it very easy to understand. So, really who is at risk as the answer might surprise many people. We tend to think of things involving the heart as an older generation, something that happens with immunocompromised or elderly. Tell us a little bit about it.

Dr. Karas: Really all of us are at risk for myocarditis. And the reason for this is because one of the most common causes are viruses. And these viruses often are the viruses that cause things like the common cold. More specifically, we think about things like adenovirus, enterovirus, Coxsackie virus. You may have heard of some of these terms, but other things like influenza, hepatitis C and HIV can also cause myocarditis.

There are other causes as well. Like you mentioned patients who do have auto-immune disorders or who are immunocompromised, they may have a higher rate, due to their underlying diseases. But the reality is that any of us could develop this, at any time during our lifetime.

Host: Okay. So, let's talk now about why this has been in the news lately, because people have been saying there's a link to the COVID-19 vaccine, or even coming down with COVID itself. Can you speak about any research that we know about with these links?

Dr. Karas: Absolutely. So, COVID-19, as you know, is a coronavirus and it can also cause a viral myocarditis due to the same ways that the other types of viruses out there can cause it. So, studies have shown that patients who've undergone either a biopsy of their heart or have had an autopsy of their heart after death, we can see that there's actual virus found inside the heart muscle in some patients.

This is not commonly done in terms of actually taking a little piece of the heart to look at it under the microscope, but we can also use other ways to try and diagnose myocarditis in patients who have COVID-19. And some of these ways is just talking to patients and listening to what their symptoms are. So, for instance, things like chest pain or shortness of breath and fatigue, which unfortunately can just accompany COVID-19 in general, might sort of clue you into that the patient may have developed myocarditis.

But we also use more specific things like looking at a patient's EKG and looking for certain abnormalities on it. Or seeing that a patient has developed an arrhythmia, as a result of the virus. In addition, we can use things like blood tests to look at very specific types of heart enzymes in the bloodstream or other inflammatory markers that we can measure. And then finally, usually imaging tests can be very helpful. So, a very simple test is an ultrasound of the heart called an echocardiogram. And with this, we can take a look at the heart function and the valve functions and how the heart is doing. And this may help us to make the true diagnosis. Overall though, true myocarditis is still pretty rare in COVID-19.

Some of the studies that have been published in the major medical journals have shown that overall it's still only about less than 1% of all hospitalized patients have true clinical manifestations of myocarditis. In regards to COVID vaccinations, there has been a link between the mRNA vaccines and the development of myocarditis. There have been several studies published very recently in the New England Journal of Medicine, which is one of the premier medical journals, looking at what is the true incidence of this. So, some of the reports have come out of Israel. And in December, they published that of the 2.5 million people that they vaccinated over the age of 16, they found that 54 people met the criteria for myocarditis, which gave them an estimated incidence of 2.13 cases per 100,000 persons. What they did find though, is that the highest incidence of myocarditis did occur in young men who were ages 16 to 29. But the vast majority of these young men had only mild cases of myocarditis and there was only one reported death.

Similar studies have been published since then. And then more recently just actually hot off the press last week, they were specifically looking at adolescents ages 12 to 15, who had received the Pfizer mRNA vaccine and out of over 400,000 vaccinated adolescents, they reported 13 cases of myocarditis. Again, almost all the cases were mild and almost all of them occurred in males. But I think the important thing to remember here is that the development of myocarditis after the vaccine, overall, is quite rare. And in general, it's very mild and self-limiting. So, I know that even on the press, we've heard so much about this, you know, I still want to recommend for everybody to still receive a COVID vaccine, but it's important for all of us to be aware of the existence, especially us physicians, because when patients are coming to be evaluated for different symptoms, we need to keep this diagnosis in mind and make sure that we make the right diagnosis and treat patients appropriately.

Host: That brings up a great point Dr. Karas is that is it sometimes not even diagnosed? And as you said, it could be quite mild. Are people coming to you after their kids have received the vaccine, their teenage boys or really anybody with some symptoms that you say could be nonspecific, they could be just symptoms of COVID or side effects from the vaccine. How do we know to go to the doctor?

Dr. Karas: Yeah, this is a great point. In general, myocarditis from viruses, all sorts of viruses, most oftentimes goes undiagnosed because the symptoms that you feel, are also the symptoms that you may get just from being infected from the virus in general. So, again, feeling tired, a little bit short of breath, not able to walk as fast as you normally may walk. You may feel some palpitations, just not feeling yourself. It's hard to know am I sick enough to go to the doctor or not? And so overall, we still don't know what the true incidence of viral myocarditis is because so many people just are at home, don't actually end up going to see the doctor and they ultimately just get better on their own.

But for those people who do come to the doctor, this is where we want to use some other types of testing to figure out, is this really a true viral myocarditis, or is this really a myocarditis that's caused by the COVID vaccine? And this is where it is important to do things like an EKG. Do some blood tests and get some form of imaging of the heart, whether that's an echocardiogram, an ultrasound of the heart, or sometimes we even use a cardiac MRI, which can give us a little bit more specific information about how the heart muscle looks.

Host: Really interesting. And I have to thank you so much for coming on with us and clearing a lot of this up. People are definitely concerned and it's, you know, as you said, it's been in the media a lot. Are there treatments that you do if you determine that somebody does have it, or are there some steps that we can take to prevent myocarditis if we're getting the vaccine or hopefully not getting COVID? Are there anything you feel important to note?

Dr. Karas: So, people have looked into this question a lot because there are a group of patients who can get very sick from myocarditis and so we want to know, is there something we could do to either prevent progression or to treat people who are really sick and in the hospital, for instance. Unfortunately, we have looked at things like antiviral agents or different types of immunosuppression. But none of these have really been shown to help treat viral myocarditis. We do know that for those patients that do develop heart dysfunction, we use traditional therapies to treat heart failure, such as drugs in the drug classes called beta blockers, ACE inhibitors, and special types of diuretics.

There is ongoing research to try and determine whether other types of antiviral agents may be beneficial. Now, when we talk about specific types of myocarditis caused by auto-immune diseases, those have been shown to respond to immunosuppression, things like steroids and other immunomodulating agents.

And so that is something that you do want a provider who is experienced in treating myocarditis, treating you. In regards to prevention, I think we've all heard a lot about hand-washing and the importance of that in during this pandemic, but this should be for all times we should all try to, the best way to prevent viral infection is to wash your hands.

Currently, you know, wearing masks indoors has still been really important, in the era of COVID and I can't emphasize enough the importance of getting both a COVID vaccine and a flu vaccine. Finally, I think it would be hard for me not to mention leading a heart healthy lifestyle, meaning that you're eating a good diet, getting regular exercise and following with a primary care doctor.

Host: That's great advice. You've given us so much really quality information today. Thank you so much, Doctor for joining us and clearing that up for a lot of the listeners. Weill Cornell Medicine continues to see our patients in-person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

Thank you for listening to today's special episode of Kids Health Cast that comes from our Back to Health series That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple podcast, Spotify and Google Podcast. For more health tips, go to Weill and search podcasts. I'm Melanie Cole.

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