Cardiac effects of drugs and vaccines used to treat and prevent COVID-19

We conducted a comprehensive examination of the cardiac adverse effects associated with drugs and vaccines approved or authorized for emergency use in the treatment and prevention of COVID-19. We also considered non-COVID-19 scenarios when relevant. Our analysis explored the limitations of attributing cardiac adverse events based on individual case safety reports and unblinded trials that lack controls for comparable disease severity. We specifically discussed the cardiac effects of medications such as Remdesivir, Nirmatrelvir-Ritonavir, Molnupiravir, Anakinra, Tocilizumab, and Baricitinib. We also explored the use of inflammation markers as a guide for antiinflammatory and immunomodulatory therapy with Anakinra in the context of COVID-19. Furthermore, we examined the incidence, pathogenesis, clinical presentation, prognosis, and risk factors of myocarditis and pericarditis following COVID-19 vaccine administration. Factors such as age, gender, vaccine type, vaccine dosage, timing of doses (first, second, booster), and intervals between doses were among the aspects discussed. Additionally, we briefly reviewed the association between adenovirus vaccines and thrombotic and bleeding events.