Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Electrocardiogram, Implantable cardiac monitor insertion, Magnetic resonance imaging heart, Myocarditis, Ventricular tachycardia
Clinical narrative: Spring / summer of 2021 after first vaccine doses, started noticing occasional chest flutters.   After many tests including a heart mri at facility, myocarditis was identified as possible / probable cause.   Started on metoprolol 12.5 mg daily  June 2022 - 3 days after receiving the 4th covid vaccine, I experienced a Ventricular Tachycardia event.  An study was performed at Hospital in July 2022 and a specific reason for the VT was not identified.   I had an ICM implanted and have not experienced any further cardiac events.  Background  I have CLL and started being treated with Acalabrutinib about the same time the initial heart flutters were felt (spring/summer 2021).  Both Acalabrutinib and Covid vax are possible causes.  Numerous tests - EKG, echocardiogram (hospital),  heart mri and stress test.  After MRI, cardiologist diagnosed as myocarditis and Rx metoprolol.  In fall of 2021, I switched from Acalabrutinib into a clinical trial for an experiment BTK inhibitor LP-168. for my CLL.  Dr is my oncologist and most familiar with this entire situation.  In spring of 2022, I experienced some dizziness  clinical trial personnel ordered a heart holster to determine if I was having any heart rhythm problems.  A couple days into wearing this holster (6/13/22) , a VT event was recorded early in the morning when I was asleep.  i did not notice anything.  The EV event lasted 19 sec with a max heart rate of 157 and resolved itself.  The VT occurred 3 days after having received the 4th Covid vax dose.  Despite an study, the exact cause of the VT event has not been determined.  There was no apparent permanent heart wiring issues from the study.  It is not clear if the heart issues (myocarditis and VT event) were caused by the covid vax or something else.  Some other factors which may be relevant:  - I have a farm and am quite active outside in spring.   It is possible I was experiencing some dehydration which was causing the dizziness and may have caused the VT.   I try to drink lots of water but it had been purified bottled water.   After discussion with my Drs, I started drinking Smart Water which has some of the essential nutrients added.   When I started using Smart Water, the dizziness decreased.  I am not sure if I started drinking the Smart Water before or after the VT event.  - As noted, I have been taking an experimental BTK inhibitor LP-168 for my CLL.   There had not been any issues with heart rhythm with this drug but to be cautious, I discontinued using it until the study could not identify any cause.  My oncologist did not believe the LP-168 caused the issue and I restarted the drug.   I also had an ICM implanted to monitor my heart rhythm.  6+ months later, there have not been any VT or other cardiac events recorded.  - The VT event occurred at night when I was asleep.   Earlier in the day, I was cleaning an area under a cracked shower pan which had become moldy.   I was exposed to the mold and to an anti-mold agent.     - I have sleep apnea and use a CPAP.  My CPAP reports do not show any significant abnormal events on the day of the VT.  - I have a lot of sinus congestion issues and routinely go to sleep with a Halls cough drop in my mouth.    I don't know that I did but it is possible that I choked momentarily on the cough drop.     - Throughout the night, I change sleeping positions several times - back, right side, left side.  Other conditions and drugs:  I am 71, obese, have several chronic conditions - OSA, high blood pressure, cholestrol.  I take various medications to address the issues above.   These include:  Mucinex, Flonase (50 mcg), azelastine .15% nasal spray to address sinus congestion lisinopril 20 mg (blood pressure) lovastatin 20 mg (cholesterol) levothyrozine 50 mg (throid) valtrex 500 MG (shingles prevention) LP-168 100 mg (cll clinical trial med) metoprolol 25 mg (heart) sildenafil 50 mg (rarely used and don't remember using it during any of the events)  I listed all of the covid vaccine doses above.   Dates of each dose are as follows:  Dose 1 - 2/11/21 Dose 2 - 3/4/21 Dose 3 - 10/1/21 Dose 4 - 6/10/22  (VT event occurred 3 days later)  I participated in an study to determine antibodies created by the covid vax.   I tested after the first 3 doses and did not record any antibodies.  It is difficult to say definitively that the covid vax caused my cardiac issues but it is certainly one of the possible causes.