Palpitation post-vaccination: What should we do?

In this clinical dilemma, we highlight the case of a previously healthy 37-year-old lady who presented to a primary care clinic with palpitations, chest discomfort and difficulty breathing within 2 hours post-mRNA COVID-19 vaccine injection. During the initial presentation to the clinic and subsequent admission to the ward, there were no significant findings except for intermittent palpitations, which were relieved by supine positioning. Serial electrocardiograms and blood investigations, including troponin-I and thyroid function tests, revealed normal findings. Given persistent symptoms, further referrals were made. She underwent a tilt table test, which demonstrated normal results. Cardiac MRI showed myocardial oedema and inflammation at the basal anteroseptal wall. Herein, we discuss several differential diagnoses, clinical features and appropriate management for this patient. This case highlights the importance of having a high clinical index of suspicion and involving a multidisciplinary team in managing a case with a diagnostic dilemma.