Age: 16.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Axillary pain, C-reactive protein increased, Chest X-ray normal, Chest pain, Echocardiogram
Clinical narrative: Patient admitted with presumed myocarditis s/p dose #2 of COVID vaccine.    From the discharge summary: a previously healthy 16 year old young man who received his covid vaccine (2nd, Pfizer) 2 days ago and had fever/myalgia/injection site pain yesterday then starting yesterday evening began having chest pain. The other symptoms resolved by this AM but chest pain was persistent and worse, described as worse lying flat and with deep breaths, with some left axilla pain as well. He went to the hospital and was found to have an elevated troponin on an adult scale and ST changes but was stable so planned transfer to ED; normal CBC. He received a dose of ketoralac and chest pain has for the most part resolved by arrival here. In the ED Trop was >0.6 and EKG with early repol and non-specific ST changes without other signs of strain.   ROS: From a CV symptom perspective, the patient has not experienced any chest pain, dyspnea, orthopnea, peripheral edema, palpitations, or syncope. 10-point review of symptoms was performed and otherwise negative except as noted above.   In the ED, afebrile with normal vital signs for age. Exam with overall well appearing male with normal cardiorespiratory exam, abdominal exam. EKG with early repolarization in lateral leads, CXR without infiltrates or PTX, normal cardiac silhouette. Labs notable for elevated troponin to 0.65. Pain resolved following toradol. Given concern for post-covid vaccine myocarditis, cardiology consulted and recommended admission for serial troponins, formal echo, and further monitoring.   PMHx: None  PSHx: None  Meds: none  Allergies: NKDA  FHx: No family history of congenital heart disease, sudden cardiac death (including drownings or car accidents), arrhythmias/pacemaker, cardiomyopathy, heart transplant, or early MI/stroke. No family history of blood clots.   Hospital Course: (5/28 - 6/1) Patient admitted to 8E in stable condition. Serial troponins and EKGs obtained. He initially downtrended, but then had a rise in trop to max of .91 after which demonstrated stable/downtrending troponins. Inflammatory markers downtrended as well (CRP 2.1 -> 1.2).  Patient did not report any further episodes of chest pain while admitted. Formal ECHO obtained that showed qualitatively normal size and function. On EKG increasing troponin was accompanied by new T-wave inversion. This were serially monitored and prior to discharge showed stable ST wave changes without arrhythmia. Due to these changes from initial presentation, cardiac MR was obtained that showed normal function.   Overall, given chest pain and elevated troponins, patient was diagnosed with mild myocarditis, though with echo demonstrating normal function, serial EKGs without any evidence of acute coronary involvement or heart block or arrhythmia, and downtrending troponins, and resolved clinical symptomatology.  He will have follow-up with the cardiology team within the next week, and plan for 3-month in person visit for repeat echo and stress test.  Discussion surrounding exercise restriction was had with the family who is in agreement with the plan.  No new medication started or discontinued during his hospitalization.     On the day of discharge, the patient was in no apparent distress, afebrile, at baseline activity, acting and interacting appropriately.  He was tolerating p.o. intake without any issues, without chest pain without any significant headache. Family was given written and verbal discharge instructions including follow up and when to seek urgent care.  Parents agreed with plan for discharge.