COVID-19 Vaccine-Induced Subclinical Myopericarditis: Pathophysiology, Diagnosis, and Clinical Management
Main Article Content
Peter A. McCullough, MD, MPH
http://orcid.org/0000-0002-0997-6355
M. Nathaniel Mead, MSc, PhD
http://orcid.org/0009-0003-3574-4675
Nicolas Hulscher, MPH
http://orcid.org/0009-0008-0677-7386
http://orcid.org/0000-0002-0997-6355
M. Nathaniel Mead, MSc, PhD
http://orcid.org/0009-0003-3574-4675
Nicolas Hulscher, MPH
http://orcid.org/0009-0008-0677-7386
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.
Keywords:
COVID-19 mRNA vaccine, subclinical myopericarditis, myocardial inflammation, spike protein cardiotoxicity, diagnosis, clinical management
Article Details
How to Cite
MCCULLOUGH, Peter A.; MEAD, M. Nathaniel; HULSCHER, Nicolas.
COVID-19 Vaccine-Induced Subclinical Myopericarditis: Pathophysiology, Diagnosis, and Clinical Management.
Medical Research Archives, [S.l.], v. 13, n. 11, nov. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7078>. Date accessed: 13 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i11.7078.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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9. Mead MN, Seneff S, Rose J, Wolfinger R, Hulscher N, McCullough PA. COVID-19 Modified mRNA “Vaccines” Part 2: Lessons Learned from Clinical Trials, Mass Vaccination, and the Bio-Pharmaceutical Complex. Vaccine Theory Prac & Res. 2024; 3(2), 1275-1344. https://doi.org/10.56098/w66wjg87.
10. Mead MN, Rose J, Makis W, Milhoan K, Hulscher N, McCullough PA. Myocarditis after SARS-CoV-2 infection and COVID-19 vaccination: Epidemiology, outcomes, and new perspectives. Int J Cardiovasc Res Innov. 2025; 3(1):1-43. https://doi.org/10.61577/ijcri.2025.100001
11. Koizumi T, Ono M. Cardiac Multiple Micro-Scars: An Autopsy Study. JACC Case Rep. 2025;30 (5):103083. doi: 10.1016/j.jaccas.2024.103083.
12. Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med. 2023;62(22):3267-3275. doi: 10.2169/ internalmedicine.2298-23.
13. Hulscher N, Cook MJ, Stricker RB, McCullough PA. Excess Cardiopulmonary Arrest and Mortality after COVID-19 Vaccination in King County, Washington. J Emerg Med OA, 2024; 2(1), 01-11. https://www.opastpublishers.com/open-access-articles/excess-cardiopulmonary-arrest-and-mortality-after-covid19-vaccination-in-king-county-washington.pdf
14. Choi S, Lee S, Seo JW, Kim MJ, Jeon YH, Park JH, Lee JK, Yeo NS. Myocarditis-induced Sudden Death after BNT162b2 mRNA COVID-19 Vaccination in Korea: Case Report Focusing on Histopathological Findings. J Korean Med Sci. 2021;36(40):e286. doi: 10.3346/jkms.2021.36.e286.
15. Gill JR, Tashjian R, Duncanson E. Autopsy Histopathologic Cardiac Findings in 2 Adolescents Following the Second COVID-19 Vaccine Dose. Arch Pathol Lab Med. 2022;146(8):925-929. doi: 10.5858/arpa.2021-0435-SA.
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