Age: 12.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Cardiac imaging procedure abnormal, Chest pain, Myocarditis, Troponin
Clinical narrative: Brief history and medical decision making: Patient is a 12 year old previously healthy female with presented with severe right sided chest pain, elevated troponin, and EKG changes 4 days after her second dose Pfizer COVID vaccination. Baseline echocardiogram on admission demonstrated normal intracardiac anatomy with normal biventricular size and systolic function.  ID was consulted and infectious work up was sent and a cardiac MRI was preformed.  The cardiac MRI confirmed evidence of myocarditis with LGE of the LV apical free wall as well as small pericardial effusion.  Troponin peaked at 597 but has begun to trend down.  Most recent troponin is down to 60.   Patient was hemodynamically stable overnight.  Chest pain resolved on Motrin around the clock.  Troponin this morning improved at 60.  EKG repeated and no evidence of ST/T wave changes.  Echocardiogram repeated today and continues to show normal biventricular size and systolic function.  No evidence of pericardial effusion.  Telemetry reviewed and no concern for arrhythmia.  ID consulted and appreciate recommendations.  Will continue to await further infectious work up for etiology of myopericarditis.  At this time, working diagnosis is post COVID vaccine.  ID will report concern to VAERS.  Respiratory effort stable on room air.  Good oral intake.  Plan to discharge home today and follow up with myself in 1 week with repeat Troponin and echocardiogram.  Discussed the findings and recommendations with her mother at the bedside.     Progress Notes DO (Physician) ? ? Pediatric Cardiology    Today I had the opportunity to evaluate the patient for follow up on 7/21/2021 at the Hospital pediatric cardiology clinic.  She was accompanied today by her mother who assisted with the history.    HISTORY OF PRESENT ILLNESS:  As you may recall, patient is a 12 y.o. female who presented with severe right sided chest pain, elevated troponin, and EKG changes 4 days after her second dose Pfizer COVID vaccination on June 10, 2021. Baseline echocardiogram on admission demonstrated normal intracardiac anatomy with normal biventricular size and systolic function.  ID was consulted and infectious work up was sent and a cardiac MRI was preformed.  The cardiac MRI confirmed evidence of myocarditis with LGE of the LV apical free wall as well as small pericardial effusion.  Troponin peaked at 597 but has begun to trend down.  Most recent troponin prior to discharge was down to 60.  An echocardiogram was repeated and showed no evidence of pericardial effusion.  With improved troponin, normal EKG and no evidence chest pain on exam, patient was discharged home on June 13, 2021 with planned follow up with myself.   6/21/2021   Since she was last seen, she has overall done well.  She has had a few episodes of chest pain that were slightly different than previous.  These episodes occurred in the center of the chest following laughing or sneezing.  The pain was more sharp in nature and brief.  She denies any history of palpitations, shortness of breath, dizziness or syncope at rest or with activity.  She has continued to follow her exercise restrictions.  No interval hospitalizations or emergency room visit.    MEDICAL HISTORY:     Patient Active Problem List Diagnosis ? Elevated troponin ? Refusal of blood products due to religion ? Acute myocarditis