Te Kere Davey is a fit road cyclist who is a business analyst. He decided that with the “traffic light system” of restrictions looming, he would get his first COVID-19 injection on 19th November so he and his family could enjoy their summer holidays away. What he got alongside, was a diagnosis of pericarditis. This is his story.

A Healthy Person

A lifetime non-smoker, Te Kere is also a father to 3 active children. Prior to the 19th, he had not visited his GP since he enrolled at the practice. His last recollection of being at the doctor was in his teens. With the outbreak of COVID-19 at the start of last year, Te Kere & his wife decided to boost their already healthy lifestyle with multi-vitamins. The family rarely consumes takeaways or soft drinks. The Davey family has never been healthier.

With the Christmas break approaching, Te Kere decided that getting his first dose of the vaccine was the right thing to do, so the whole family could relax and enjoy getting away together. He went to a local vaccination centre at 11.30 in the morning on Friday 19th and it was uneventful. He noted that there was a person already there that was suffering chest pain after having had a shot and was “being wired up”.

After the 1st Shot

On Sunday 21st at around midday, Te Kere felt a bit of “chest squeezing”. He had been taking things easy that weekend after his injection on Friday, not undertaking any of his usual exercise. Brushing the discomfort aside, he went about the rest of his weekend.

Early on Monday 22nd at 3.30am, he was suddenly awake with a feeling of “warm intense pressure” all over his body, including tingling in his arm. He was concerned but once again brushed the discomfort aside and went back to sleep. He went to work as usual that day.

Tuesday 23rd at 4.30am, Te Kere was once again awake with more intense discomfort than the day before. This time it was accompanied by head shaking and tremors. Although he was working from home that day, he went into town to get a coffee during which the squeezing sensation in his chest intensified, he felt short of breath and the intermittent bursts of pressure radiating down his arm worsened. A call to his GP revealed his enrolment with them had lapsed and it would be several days before he could get an appointment.

So Te Kere dialed 111 even though he was slightly worried he might be wasting their time. An ECG later, the first responders were sufficiently concerned with the combination of the readings and Te Kere’s symptoms to transport him to the Hawera Hospital Emergency Department. They also sprayed something under his tongue, immediately after which the tingling and pressure in his left arm subsided.

While Te Kere didn’t know what had been sprayed under his tongue, it is common for a small amount of nitroglycerine or glyceryl trinitrate (GTN) to be administered in that way for angina attacks. Angina is chest pain or pressure caused by reduced blood flow to the heart. It is usually due to obstruction or spasm of the arteries that supply blood to the heart muscle and is a symptom of coronary artery disease. Nitroglycerin or GTN acts as a vasodilator to relax the arteries, thus increasing blood flow and easing the stress on the heart.

At The Hospital

Te Kere is full of praise for the staff at the Emergency Department (ED), who took his blood for testing, his blood pressure, conducted an X-ray of his chest and an ECG without delay. The doctor who oversaw his case was sufficiently concerned to consult with a cardiologist.

While the blood tests and blood pressure were unremarkable, Te Kere’s ECG remained abnormal. His X-ray revealed fluid accumulation around his heart. The cardiologist returned a diagnosis of pericarditis and to Te Kere’s shock, he was recommended to wait “at least 3 to 6 weeks before getting the second covid jab, and to get it done at a hospital.”

Just as alarming was the ED doctor’s opinion that the pericarditis was likely caused by Te Kere’s injection 4 days prior, as an adverse reaction. He also noted that there had been a recent rise in cardiac-related presentations to the ED.

After being discharged and later that same day, Te Kere began experiencing “severe chest pain radiating to his arm”. Understandably alarmed, his wife took him back to the hospital’s ED, which admitted him as he had already been there earlier in the day. He noted that the ED is shut to walk-ins and all admittances have to be by ambulance or GP recommendation.

Treatment

Pericarditis is inflammation of the pericardium, the thin sac-like membrane around the heart. It becomes swollen and irritated. Pericarditis often causes chest pain and sometimes other symptoms.

Te Kere has been prescribed a week-long course of colchicine, an anti-inflammatory drug that is used in the treatment of gout and pericarditis. He has also been prescribed ibuprofen.

On the Road To Recovery

Previously undertaking long bike rides daily and very physically active, Te Kere now feels puffed wandering around the garden for 10 minutes. He has to lie down to rest afterwards. In the ensuing days, he has felt better especially after completing the course of colchicine, with the pain in his arm subsiding completely. The constant heavy “squeezing” pressure has also eased.

He has finally been able to visit his GP, who is concerned about what has happened. His GP will be applying for a medical exemption from the 2nd dose for him but has noted that he has not thus far been successful in obtaining any exemptions for his patients. A response is expected within two weeks. The GP also discussed “whether I “roll the dice” and take the Pfizer shot or look at taking the Astra Zeneca shot”, although the difference between the two was not explained.

Take Your Symptoms Seriously

While Te Kere is very satisfied with the treatment he received at Hawera Hospital’s ED, he is deeply concerned by what happened during his 2nd visit. This time another ED doctor attended, who did not look at the X-ray, only at the ECG, and did not consult a cardiologist. This doctor firmly remarked to Te Kere that he would not have arrived at a diagnosis of pericarditis and brushed off Te Kere’s symptoms as “anxiety”.

Upon being presented with results of the X-ray and subsidence of symptoms after administration of the nitroglycerine spray, this 2nd doctor was unable to refute the evidence.

Te Kere has been very open about his experience and has posted publicly on his personal Facebook profile about it, including recording a video update. On the day of his diagnosis, he wrote “I’m sitting here writing this post, with the chest pressure – feels like my chest is going to cave in, and the achey left arm, and the pain in my neck. I’m. Sitting. Down. FFS.”

While New Zealanders have been constantly told that serious adverse reactions such as pericarditis are rare, it is clear that they do happen and should always be taken seriously. Attempts to minimise such symptoms, particularly by the person experiencing them, may lead to dangerous complications. Medical attention should always be sought.