Manouchehr Hekmat
1 
, Hamid Ghaderi
1 , Zahra Ansari Aval
1* , Naser Kachoueian
2 , Mahya Hekmat
3 , Roshanak Tirdad
4 , Seyedeh Adeleh Mirjafari
5 1 Department of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Cardiac Surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Shahid Beheshti University of Medical Sciences. Tehran, Iran
4 Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
In the wake of widespread COVID-19 vaccinations, a variety of complications have been reported. Among these, cardiac ischemia stands out as a rare, but significant and potentially dangerous complication, which can progress to myocardial infarction and pose a serious threat to one’s life. Our patient was a 54-year-old man with no risk factors, who developed chest pain five days after the third dose of the COVID-19 vaccine. Notably, he exhibited no symptoms after the first and second doses. For four months, the patient’s symptoms were attributed to inflammatory complications, such as pericarditis and myocarditis, as well as gastrointestinal problems. During this period, he received symptomatic treatment. Due to the persistence of symptoms, heart examinations were conducted, which revealed a constriction at the end of the left main coronary artery. Consequently, the patient underwent coronary artery bypass grafting (CABG). Following cardiac revascularization, the patient’s symptoms were successfully alleviated. Furthermore, his cardiac symptoms were successfully resolved during a six-month follow-up period. The mechanism through which asymptomatic plaques in the coronary vessels are activated following the COVID-19 vaccination or infection remains unclear. Regardless of the cause, any chest discomfort experienced after COVID-19 vaccination or infection should be treated with utmost seriousness, and examinations for acute coronary syndrome should be conducted.
Implication for health policy/practice/research/medical education:
Although cardiac ischemia following COVID-19 vaccination is rare, it can be life-threatening. In instances of COVID-19 infection or post-vaccination, any chest discomfort should be taken seriously. It is recommended that heart examinations akin to those performed for acute coronary syndrome be conducted. Post-vaccination, any chest pain experienced should be treated with utmost seriousness. In addition to considering conditions, such as pericarditis or myocarditis, it is also important to check for reduced blood supply to the heart and ischemia, even if the ECG (electrocardiogram) results appear normal.
Please cite this paper as: Hekmat M, Ghaderi H, Ansari Aval Z, Kachoueian N, Hekmat M, Tirdad R, Mirjafari SA. Presentation of a case of chest pain leading to coronary artery bypass grafting (CABG) following the third dose of COVID-19 vaccination and an overview of the possible causes of chest pain after COVID-19 vaccination. J Nephropharmacol. 2025;14(1):e11664. DOI: 10.34172/npj.2025.11664.