Abstract
The currently approved COVID-19 mRNA boosters carry a warning for acute, clinically apparent, vaccine-induced myocarditis. This serious condition has resulted in hospitalization and, in well-documented cases, fatalities. However, there is growing concern that long-lasting synthetic mRNA and persistent production of SARS-CoV-2 Spike protein may accumulate in the heart and cause cardiotoxicity over time. Additionally, subtler cardiovascular symptoms, which may not require immediate hospitalization, can also develop. Such symptoms include atypical or pleuritic chest pain, palpitations, intermittent arrhythmias, labile blood pressure with hyper- and hypotension and effort intolerance. Areas of inflammation found at autopsy too small to be detectable by cardiac magnetic resonance imaging have been associated with sudden death. Alarmingly, the initial presentation can include cardiac arrest with no premonitory symptoms. A thorough evaluation, including history of SARS-CoV-2 infections, the number and type of mRNA COVID-19 vaccines received, quantitative Spike protein antibody levels, ECG, imaging, and laboratory tests, form the cornerstone of initial assessment. Clinical and preclinical observations suggest combined oral administration of nattokinase, bromelain, and curcumin may support detoxification of the heart and cardiovascular system from Spike protein. The addition of colchicine and other targeted therapies may be essential in reducing myocardial and systemic vascular inflammation. These approaches hold promise to risk mitigation of sudden cardiac death in immunized individuals affected by subclinical COVID-19 vaccine induced myopericarditis.