Age: 13.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin increased
Clinical narrative: Chief Complaint  Post vaccine myocarditis.  History of Present Illness     Pt. is a 13 yo young man who was admitted for post vaccine myocarditis, occurring 3 days after receiving the Pfizer COVID booster. His d/c summary is noted below. He received a dose of ibuprophen in our ED and was observed overnight. He had a repeat troponin as an outpatient on 1/18/2022 which was 0.03. Since his discharge home, Pt. has been afebrile and he has not had any chest pain. No palpitations, no dizziness or syncope. ROS includes a peanut and tree nut allergy for which he has an Epipen, otherwise, no significant medical hx. Pt. is in the 8th grade. He was on a swim team (through March). He does jiu jitsu inthe spring and plays soccer three times a week but has been restricted from sports since his discharge.  Cardiology Summary Narrative   Discharge Summary 1/15-1/16/22: Pt. is a 13yo previously healthy who initially presented with complaints of chest pain 3 days after the COVID booster (booster date 1/12/2022). He reports that he woke up on 1/15/2022with an aching chest pain that was localized primarily to the substernal area and a little bit to the left but otherwise did not radiate. He does not know of any exacerbating symptoms, but the pain was relieved after about an hour and taking 2 advil. He said throughout the day it has come back a little bit, currently reporting 1/10, but nothing similar to the intensity that he felt this morning. He had his COVID Pfizer booster on Wednesday and reports only having vague fatigue with the initial 2 dose series. He has not previous experienced these symptoms nor has he been ill or in contact with anyone ill recently. He has not previously had COVID.  At hospital, they did a thorough work-up that included normal CBC, Chemistry, inflammatory markers (CRP 10, nml < 15), NT-BNP (76, nml < 450), and ECG. However, he did have serial elevation of troponins (highly sensitive, nml <14) with 94 -- > 124, so he was sent to BCH given concern of post-vaccine myocarditis.  Recent Testing:  CXR (1/15/22)  There is visceral situs solitus and a left-sided aortic arch. The heart is normal in size and shape. The pulmonary blood flow is normal and the lungs are clear.  Hospital Course:  Pt. was admitted with post vaccine booster myocarditis. He reported significant chest pain the morning of 1/15 which has since resolved. During his admission he complained of at most 1/10 chest and most recently none at all. He had two EKGS during his admission that were all normal. His labs did show a mildly elevated troponin, last 0.23 prior to d/c. An ECHO showed a structurally normal heart with no dysfunction or coronary abnormalities. Given his resolved symptoms and normal EKG and ECHO Pt. is being discharged home with plan to repeat a troponin as an outpatient on Tuesday 1/18 and follow-up with cardiology in 1-2 wks.    1/20/22 Cardiology visit: Physical Exam  Vitals & Measurements  T: 37.1  °C  (Temporal Artery)  HR: 67 (Monitored)  BP: 112/62  SpO2: 99%   Weight: 50.1 kg (58%ile)*; Height: 167.0 cm (82%ile)*; Body Mass Index: 18 kg/m2 (37%ile)*  *CDC chart used to calculate percentile value.   There was no cyanosis or clubbing, and no rash.  Neck veins were flat in the sitting position.  There were no carotid bruits.  Chest was clear to auscultation.  Cardiac exam revealed a normal cardiac impulse without thrill.  S1 was single.  S2 was physiologically split.  There were no murmurs, gallops, or clicks.  Abdomen was soft and nontender, without hepatosplenomegaly.  Pulses were full throughout, and there was no radial-femoral delay.  Extremities were warm and well perfused, and there was no pretibial edema.  Cardiology Diagnostics  EKG: HR 67 bpm. WNL   Group Detail Date Value w/Units Flags Normal Range Normal Reference Text Comment Ind  Chemistry Troponin T 01/20/2022 16:02:22 EST <0.01 ng/mL  Chemistry C-Reactive Protein 01/20/2022 16:02:22 EST 0.08 mg/dL           Assessment/Plan   In summary, Pt. is a 13 yo with recent hospitalization for post vaccine associated myocarditis, treated with ibuprofen. His presentation included chest pain and elevated troponins (normalized). He had a normal echo, normal EKG. His troponin and CRP are pending and will be added once they are resulted.  He has not had any further chest pain. The family is very medically knowledgeable (mom is a neurologist and dad is a scientist). At this time, they have decided not to pursue a cardiac MRI but will have one in March 2022. We discussed what we know about post vaccine myocarditis and, in this setting, we follow similar guidelines as those with myocarditis in order to give the myocardium time to heal. Dr discussed our recommendations for activity restrictions. Pt. should be restricted from competitive/vigorous sports for the next 2-3 months and will return for a cardiac MRI for LGE in March, 2022.