Case Report: Cryptic evidence on underreporting of mRNA vaccine-induced myocarditis in the elderly: a need to modify antihypertensive therapy

BACKGROUND: Myocarditis has been considered a rare complication of COVID-19 vaccination that primarily affects young people. However, recent studies indicate under-reporting of cases in the elderly. Furthermore, post-mortem studies of five cases (median age 58) that died suddenly within 7 days of vaccination, indicate an autoimmune element. Albeit an individual case history, the author’s unexpected personal evidence supports the latter studies. METHODS: Readings of blood pressure (BP) and pulse were taken twice daily. RESULTS: Seven days after the fifth of a series of anti-COVID-19 vaccinations, a “stress test” (15 min jog) in an elderly subject exposed a cardiac problem – arrhythmia and a rapid fall of BP with slow recovery. The timing suggested myocarditis as a post-vaccination _early_ side-effect that usually targets those more likely to exercise (i.e., the young). Thus, it is usually cryptic in the elderly. In addition, retrospective studies of his own BP readings during the vaccination period (2021-2023) revealed the sudden emergence of transient, but prolonged, falls of BP _several weeks_ after each of his last four vaccinations. These hypotensive episodes were cryptic (asymptomatic) and likely not detected in shorter post-vaccination analyses. CONCLUSIONS: Short-term post-vaccination side effects are distinct from those occurring after some weeks. The first category includes systemic or localized inflammatory responses that, in the case of the heart, might either trigger arrythmia and acute functional impairment, or remain cryptic. Localized responses could initiate tissue damage, culminating weeks later in the second category – asymptomatic but measurable functional impairment. Continuing regular dosages of antihypertensive medication during this period would likely intensify the hypotension. That this did not occur in the author’s case is attributed to his two-decade-long practice of modulating dosage daily, based on BP readings. Failure to follow this protocol might explain some sudden home deaths. A parallel is drawn with his previous study that showed the need to modify antihypertensive therapy in response to external temperature changes.

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