Severe And Overlapping POTS With Myocarditis After A 2nd Dose Of Pfizer's COVID-19 Vaccine In A Healthy 13-Year-Old Child With Debilitating Symptoms Lasting Over 7 Months
A Case-Study And Lesson
Before reading the analysis of this case study, please understand this. Specifically, many individuals present to their physicians with signs/symptoms of POTS post mRNA COVID-19 vaccination which can then lead to formal diagnosis. However, the case study examined below implicates that it may be important to search for myocarditis in the presence of POTS after mRNA vaccination.
Overlapping Myocarditis and Postural Orthostatic Tachycardia Syndrome After COVID-19 Messenger RNA Vaccination: A Case Report
A young, previously healthy, 13-year-old male presented to hospital 15 days post 2nd dose of Pfizer's COVID-19 vaccine with severe fatigue, and headache that prevented him from leaving bed during the day and began 1 day post vaccination.
ED assessment revealed normal vitals, heart sounds, and neuro exam. However, AST (active standing test) showed immediate jump in HR from 65-140 bpm from sitting to standing position. That and other other signs/symptoms justified new POTS diagnosis.
Treatment was started and included NSAIDS, Tylenol, Herbs (Goreisan + Kakkonto) for headache and fatigue. Also, midodrine, was started, an antihypotensive/vasopressor to improve blood pressure.
After that, patient was discharged and advised to increase salt/fluid intake, and exercise.
Unfortunately, patient presented to emergency department again 2 weeks later for severe fatigue, lightheadedness, palpitations, and sleeplessness associated with recently diagnosed POTS syndrome. Essentially, symptoms worsened after previous hospital discharge.
2nd Hospital assessment:
➡️ ECHO + MRI found slight pericardial effusion (fluid build-up within heart pericardium) at R-front ventricle
➡️ Increased CKMB 11 ng/mL (norm 0-6)
➡️ Increased troponin I 33.8 pg/mL (norm 0-30)
➡️ Normal thyroid panel
➡️ Normal 72% ejection fraction
Soon after, myocarditis was diagnosed which made this the first case-study to implicate myocarditis and POTS concurrently diagnosed post 2nd COVID-19 mRNA vaccination with Pfizer.
Moving on, hospital treatment was started that included 1.5L IV saline Q day for POTS, pregabalin 100 mg 2X daily for headache, ramelteon for sleeplessness which didn't meaningfully improve patient's symptoms.
However, 75 days post vaccination, patient was given IVIG and notable improvements in health occurred within 3 days. Patient was able to leave bed and walk for several kilometers but only at night. Also, CKMB, and troponin I normalized.
Fast-forward 7 months. Specialist found AST head-tilt test exhibited a >40 bpm increase in HR. Moreover, standing resulted in immediate 15 mmHg drop in both systolic and diastolic BP measurements. Despite that, POTS was confirmed.
Hopping ahead to 7.5 months post initial insult, patient still suffered debilitating symptoms that only allowed him to briefly get out of bed half way through the day. Sadly, medications like midodrine were tripled in dose, and propranolol was added to be taken 2X daily.
As a final note, this case-study implicated the possibility of myocarditis, and POTS occurring together post mRNA COVID vaccination and the possible need to assess for myocarditis if symptoms of POTS present initially.
LETS CONNECT:
So tragic for parents who believe they are doing the right thing by following the advice of their doctors and the CDC. I learned after my daughters were forever changed following the Gardisil vaccinations to be wary of new vaccines that are heavily promoted. Very, very sorry for this child and his parents.
I’m so sorry this child is suffering. His life is certainly shortened for no good reason. A parent always runs through everything in their mind about cause if a child is sick or hurt. The jab cause must be on the table. I wouldn’t want to be those parents for sure. Devastating.