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COVID-19 vaccine and heart patients: An expanded Q/A

Our expert answers your questions about the safety and efficacy of the COVID-19 vaccine — and the possible need for booster shots — for people with heart conditions.  

Female heart patient, older adult Photo: Getty Images

Since this story was originally published, new information has become available about Johnson & Johnson COVID-19 vaccine availability. For the most up-to-date information on this topic, please visit the VCU Health COVID-19 vaccine page(Updated July 18, 2023 to reflect new information)

People with underlying medical conditions are getting the COVID-19 vaccine. But is the vaccine safe for people with heart disease or cardiovascular risk factors?

Here Dr. Antonio Abbate, a heart specialist with the VCU Health Pauley Heart Center, answers your questions about the safety and efficacy of the COVID-19 vaccine for heart patients.

Dr. Antonio AbbateI’m nervous about vaccines. Are the COVID-19 vaccines truly effective? They were developed in less than a year.

As a heart patient, you should have no concerns about the speed with which the vaccines were developed. The Pfizer-Biontech, Moderna and Johnson & Johnson vaccines were tested on a very large number of patients and shown to be safe and effective. Heart disease and stroke medical experts urge the public to get the COVID-19 vaccinations.

The Johnson & Johnson vaccine was widely available and safe to use in 2021 and 2022. According for the Centers for Disease Control and Prevention, the Johnson & Johnson COVID-19 vaccine is no longer available in the United States, as the remaining stock expired May 7, 2023. People ages 18 years and older who received 1 or 2 Johnson & Johnson vaccine doses are recommended to receive 1 bivalent mRNA dose (Moderna or Pfizer-BioNTech) at least 2 months after the previous shot.

Are the vaccines safe for people with a history of heart disease, heart attack or cardiovascular risk factors?

Not only are the vaccines safe for people with a history of heart disease, they are essential. People with heart disease are at increased risk of severe complications from COVID-19.

On January 15, 2021, the American Heart Association released a statement urging all eligible individuals to get vaccinated to keep themselves, their family and their community healthy and safe:

“As a science-based organization committed to health equity, we are heartened that COVID-19 vaccines have been approved to protect individuals, their loved ones and their communities from the pandemic. The American Heart Association – which has been carefully tracking COVID-19 and its disproportionately negative effects on older adults; people with underlying medical conditions; and Black, LatinX and American Indian/Alaska Native people – strongly encourages everyone to get vaccinated with any approved COVID-19 vaccine as it is available.

In particular, people with cardiovascular risk factors, heart disease, and heart attack and stroke survivors should get vaccinated as soon as possible because they are at much greater risk from the virus than they are from the vaccine.”

Do the vaccines protect against omicron? Do I need a booster?

Like all viruses, the virus causing COVID-19 mutates frequently. These variants may differ in their ability to infect, trigger an immune response and induce illness.

The omicron variant is one of the more recent strains of the virus causing COVID-19. It is even more contagious than earlier strains, causing a new surge in cases. To best protect yourself against omicron and other variants, it's important to complete your primary vaccination series and get boosted.  

What are the side effects of the COVID-19 vaccine? Will the side effects be any different for people with a heart condition or cardiovascular disease?

The most common side effects of the vaccines are pain and bruising at the site of the injection, and in some cases feeling tired or achy. You may also run a low-grade fever. As a heart patient, your symptoms are no different than those of everyone else. Symptoms generally last less than two days.

Should I be concerned about myocarditis or pericarditis after getting the COVID-19 vaccine? What are the warning signs?

Myocarditis and pericarditis refer, respectively, to inflammation of the heart muscle or the pericardium —  the sac surrounding the heart. Myocarditis and pericarditis can occur after a viral infection, including COVID-19, as a result of an exaggerated immune response. Myocarditis and pericarditis can also occur after a vaccination, likely related to the immune response generated by the vaccine.

The Centers for Disease Control and Prevention (CDC) has released data showing a small increase in cases of myocarditis and pericarditis after receiving the mRNA COVID-19 vaccination (the Pfizer and Moderna two-dose vaccines), especially in young adults. In the great majority of cases, though, the myocarditis and pericarditis were mild and resolved on their own.

Risk of these complications is very low. However, if you experience chest pain or discomfort, shortness of breath, nausea or vomiting in the days following your COVID-19 vaccination, it would be prudent to seek medical attention to exclude these or other rare complications of the COVID-19 vaccine.

Should I be concerned about thrombosis after vaccination? What are the warning signs?

Thrombosis is an abnormal clot formation that cause stroke, heart attack and other major issues. COVID-19 is associated with a very high risk of thrombosis, therefore a high risk of death.

In some very rare instances, an abnormal immune response has been associated with the COVID-19 vaccine. In those cases, the number of platelets your body manufactures goes down and a clot forms. This is very rare — less than 1 in 50,000 cases, seen primarily in individuals receiving the AstraZeneca COVID-19 vaccine. This vaccine is currently not in use in the United States.

If you experience severe headache, trouble seeing, loss of strength or balance, chest pain or discomfort, nausea or vomiting in the days following your COVID-19 vaccination, it would be prudent to seek medical attention to exclude this or other rare complications of the COVID-19 vaccine.

I hear some people have an allergic reaction. As a heart patient, will I have an increased risk of an allergic reaction?

People with heart disease are not at increased risk of an allergic reaction. Allergic reactions have been reported in only rare cases.

Does my heart condition make me more vulnerable to COVID-19?

People with heart disease are not at higher risk of being infected by the SARS-CoV2 virus, which causes COVID-19.

Am I at greater risk of severe symptoms, or even death, if I get COVID-19? 

Unfortunately, people with heart disease are more likely to have a severe or critical case of COVID-19.

In this recorded webinar, Dr. Abbate and Dr. Keyur Shah discuss the latest research on the risk COVID-19 has had on people with heart conditions, and how the virus has affected heart health.

Can people on blood thinners get the vaccine? 

Definitely yes. You may get a bigger bruise on your arm, where you got the injection, due to the blood thinner. But this shouldn’t be a concern. If you notice a large bruise that is painful or continues to enlarge, though, ask your doctor about it.

Where can I get the vaccine?

You can get the vaccine at many locations, including VCU Health. Everyone over age 5 is now eligible for vaccination. Most pharmacies offer the primary vaccination series as well as booster shots. It’s easy to schedule an appointment online. If you can’t get an appointment, check with your doctor or a local urgent care facility. You can also visit theVirginia Department of Health to find a vaccination site close to you.  

What happens after I get the vaccine? Can I stop wearing my mask and social distancing?

None of the vaccines are 100% effective. An efficacy rate of 95%, for instance, means that some people who get vaccinated (1 in 20) may still get COVID-19.

If you are one of the many who do develop immunity, it usually takes 2-4 weeks after you complete the vaccine series to do so. You could get infected during this time, endangering your health. You might also still be able to spread the disease, both during this 2-4 week window as well as after you develop full immunity, endangering others.

Once most people are protected, restrictions may ease up. In the meantime, continue to wear your mask, practice social distancing, avoid crowds and wash your hands often.

As a heart patient, are there any extra precautions I should take to reduce my chances of getting COVID-19?

Everyone should observe the common practices of social distancing, wearing a mask, washing your hands frequently and avoiding gatherings — especially in closed spaces. People with heart disease should be particularly careful, given your increased risk of severe or critical COVID-19.

If I’m sick with COVID-19, will I need to be admitted to the hospital?

Thankfully most people with COVID-19 don’t need hospitalization. If you’re diagnosed with COVID-19, you may be able to monitor your condition at home with the help of your doctor.

What treatments can I take at home for COVID-19 that will not interfere with my heart condition and medications?

Everyone’s condition is different, so it’s best to check with your doctor before taking any medications. In general, acetaminophen, when used as directed, is the safest medication for fever. 

For more information

For a variety of news and information on COVID-19 and how VCU Health is keeping you safe, please visit our COVID-19 News Center

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