Dr Peter McCullough: Assessing Heart Attack Risk After COVID-19 Vaccination (2024)

Rationale for Risk Stratification

We continue to observe COVID-19 vaccinated persons suffer cardiac arrests since the inception of the mass vaccination campaign in late 2020 [1–5]. Figure 1 illustrates the likely mechanisms. Both Pfizer-BioNTech (BNT162b2) and Moderna (mRNA-1273) mRNA have been found in human heart muscle at autopsy [6]. Spike protein has been stained in endomyocardial biopsy samples of young men suffering from COVID-19 vaccine-induced myocarditis [7]. Victims have been found to have circulating Spike protein but ineffective antibodies, likely IgG4 subclass, that fail to neutralize Spike protein and allow its assault on the heart [8]. Positron emission tomography data have revealed a shift from free fatty acid metabolism to glucose metabolism in the hearts of the majority of individuals who have received a COVID-19 vaccine. [9]. The PET pattern resembles global ischemia. This could be due to vaccine Spike protein hemagglutination in myocardial capillaries or cellular changes in mitochondrial respiration and substrate metabolism [10]. Small patches of dysfunctional, inflamed, or scarred myocardium are sufficient to serve as a nidus for re-entrant ventricular tachycardia that can degrade to ventricular fibrillation and lead to cardiac arrest [11]. A surge in catecholamines (epinephrine, norepinephrine, and dopamine) that can occur during sports or the waking hours of sleep (3 AM to 6 AM) may trigger reentrant ventricular tachycardia or spontaneous ventricular fibrillation leading to a cardiac arrest in patients with COVID-19 vaccine subclinical myocarditis [12].


Risk Stratification Approach

When patients are seen in clinical practice for the initial evaluation of cardiovascular symptoms following SARS-CoV-2 infection or vaccination, a proposed approach is outlined in Figure 2. COVID19 vaccine-induced myocarditis is caused principally by the Spike protein [7,8,16,24]. Measures of cytokine activation and inflammation are secondary to Spike protein resident in the myocardium and circulating in blood [7,8].


When risk stratification indicates low-risk, primary care office management is suggested with McCullough Protocol: Base Spike Detoxification and adjunctive medications depending on the syndrome (Figure 3) [25]. For subclinical myopericarditis, oral colchicine 0.6 mg BID (twice a day) or QD (once a day) is indicated for at least one year [45]. For COVID-19 vaccine-induced postural orthostatic tachycardia syndrome (POTS), use of colchicine and nadolol 20-40 mg BID can be helpful [46]. In patients who screen as high-risk, Base Spike Detoxification [25] is also indicated. For those at very high risk for cardiomyopathy and or ventricular arrhythmias, formal cardiology consultation is suggested with the main goals of preventing heart failure and sudden death. Additionally, some patients may require ICD implantation if there are symptomatic arrhythmias, LGE > 15%, or genetic predictors such as pathogenic SCN5A mutations [37,47].

Figure 3. McCullough Protocol: Base Spike Detoxification (BSD)

A: Dissolution of spike proteininduced thrombus. Nattokinase directly degrades fibrinolysis-resistant fibrin (from spike protein), and bromelain upregulates fibrinolysis. 

B: Inhibition of spike protein via ACE2 receptors. Bromelain and curcumin block the ACE2 receptor, preventing spike protein from binding. 

C: Proteolytic degradation of spike protein. Nattokinase and bromelain degrade spike proteins, rendering them inactive. 

D: Attenuation of spike protein-induced inflammation. Bromelain and curcumin downregulate the NF-kB signaling pathway induced by spike protein, leading to the suppression of inflammatory molecules. 

E: BSD treatment protocol. The full treatment regimen and the addition of other compounds based on clinical indication are illustrated. 

Abbreviations: TPA = tissue plasminogen activator, PAI-1 = plasminogen activator inhibitor-1, ACE2 = angiotensin converting enzyme-2, NF-kB = nuclear factor kappa B, S1/S2 = spike protein subunits S1/S2, TLR4 = toll-like receptor 4. *Figure and legend reprinted from Hulscher et al [25]. 

Autopsy Results in Fatal Cases of Heart Inflammation from COVID-19 Vaccines

The top National Library of Medicine PubMed study for COVID-19 Vaccine-Induced Myocarditis is currently Dr Peter McCullough's paper: 'Autopsy Findings in Cases of Fatal COVID-19 Vaccine-Induced Myocarditis', published in the European Society of Cardiology's journal (2024).


References 

1. Hulscher, N.; Cook, M.; Stricker, R.; McCullough, P. A. Excess Cardiopulmonary Arrest and Mortality after COVID-19 Vaccination in King County, Washington. Preprints 2024, 2024051665. https://doi.org/10.20944/preprints202405.1665.v1 

2. Li YE, Wang S, Reiter RJ, Ren J. Clinical cardiovascular emergencies and the cellular basis of COVID-19 vaccination: from dream to reality?. Int J Infect Dis. 2022;124:1-10. doi:10.1016/j.ijid.2022.08.026 

3. Sun CLF, Jaffe E, Levi R. Increased emergency cardiovascular events among under-40 population in Israel during vaccine rollout and third COVID-19 wave [published correction appears in Sci Rep. 2023 Aug 15;13(1):13276. doi: 10.1038/s41598-023-40234-1]. Sci Rep. 2022;12(1):6978. Published 2022 Apr 28. doi:10.1038/s41598-022-10928-z 

4. Sadiq W, Waleed MS, Suen P, Chalhoub MN. Cardiopulmonary Arrest After COVID-19 Vaccination: A Case Report. Cureus. 2022;14(1):e21141. Published 2022 Jan 12. doi:10.7759/cureus.21141 

5. Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med. 2023;62(22):3267-3275. doi:10.2169/internalmedicine.2298-23 

6. Krauson AJ, Casimero FVC, Siddiquee Z, Stone JR. Duration of SARS-CoV-2 mRNA vaccine persistence and factors associated with cardiac involvement in recently vaccinated patients. NPJ Vaccines. 2023;8(1):141. Published 2023 Sep 27. doi:10.1038/s41541-023-00742-7 

7. Baumeier C, Aleshcheva G, Harms D, et al. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. Int J Mol Sci. 2022;23(13):6940. Published 2022 Jun 22. doi:10.3390/ijms23136940 

8. Yonker LM, Swank Z, Bartsch YC, et al. Circulating Spike Protein Detected in Post-COVID-19 mRNA Vaccine Myocarditis. Circulation. 2023;147(11):867-876. doi:10.1161/CIRCULATIONAHA.122.061025 

9. Nakahara T, Iwabuchi Y, Miyazawa R, et al. Assessment of Myocardial 18F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2-vaccinated and Nonvaccinated Patients. Radiology. 2023;308(3):e230743. doi:10.1148/radiol.230743 

10. Scheim DE, Vottero P, Santin AD, Hirsh AG. Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19. Int J Mol Sci. 2023;24(23):17039. Published 2023 Dec 1. doi:10.3390/ijms242317039

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12. Cadegiani FA. Catecholamines Are the Key Trigger of COVID-19 mRNA Vaccine-Induced Myocarditis: A Compelling Hypothesis Supported by Epidemiological, Anatomopathological, Molecular, and Physiological Findings. Cureus. 2022;14(8):e27883. Published 2022 Aug 11. doi:10.7759/cureus.27883 

13. Polykretis P, McCullough PA. Rational harm-benefit assessments by age group are required for continued COVID-19 vaccination. Scand J Immunol. 2023;98(1):e13242. doi:10.1111/sji.13242 

14. Alessandria M, Malatesta GM, Berrino F, Donzelli A. A Critical Analysis of All-Cause Deaths during COVID-19 Vaccination in an Italian Province. Microorganisms. 2024; 12(7):1343. doi: 10.3390/microorganisms12071343 

15. Faksova K, Walsh D, Jiang Y, et al. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine. 2024;42(9):2200-2211. doi:10.1016/j.vaccine.2024.01.100 

16. Hulscher N, Hodkinson R, Makis W, McCullough PA. Autopsy findings in cases of fatal COVID-19 vaccine-induced myocarditis. ESC Heart Fail. Published online January 14, 2024. doi:10.1002/ehf2.14680 

17. Rose J, Hulscher N, McCullough PA. Determinants of COVID-19 vaccine-induced myocarditis. Ther Adv Drug Saf. 2024;15:20420986241226566. Published 2024 Jan 27. doi:10.1177/20420986241226566 

18. Long Term Follow-Up After Administration of Human Gene Therapy Products [Internet]. FDA; 2020 [cited 2024 Aug 5]. Available from: https://www.fda.gov/media/113768/download 

19. Krumholz HM, Wu Y, Sawano M, et al. Post-Vaccination Syndrome: A Descriptive Analysis of Reported Symptoms and Patient Experiences After Covid-19 Immunization. Preprint. medRxiv. 2023;2023.11.09.23298266. Published 2023 Nov 10. doi:10.1101/2023.11.09.23298266 

20. Shrestha Y, Venkataraman R: The prevalence of post-COVID-19 vaccination syndrome and quality of life among COVID-19-vaccinated individuals [IN PRESS]. Vacunas. 2023, 10.1016/j.vacun.2023.10.002

21. Said KB, Al-Otaibi A, Aljaloud L, et al. The Frequency and Patterns of Post-COVID-19 Vaccination Syndrome Reveal Initially Mild and Potentially Immunocytopenic Signs in Primarily Young Saudi Women. Vaccines (Basel). 2022;10(7):1015. Published 2022 Jun 24. doi:10.3390/vaccines10071015 

22. Brogna C, Cristoni S, Marino G, et al. Detection of recombinant Spike protein in the blood of individuals vaccinated against SARS-CoV-2: Possible molecular mechanisms. Proteomics Clin Appl. 2023;17(6):e2300048. doi:10.1002/prca.202300048 

23. Yu CK, Tsao S, Ng CW, et al. Cardiovascular Assessment up to One Year After COVID-19 VaccineAssociated Myocarditis. Circulation. 2023;148(5):436-439. doi:10.1161/CIRCULATIONAHA.123.064772 

24. Parry PI, Lefringhausen A, Turni C, et al. 'Spikeopathy': COVID-19 Spike Protein Is Pathogenic, from Both Virus and Vaccine mRNA. Biomedicines. 2023;11(8):2287. Published 2023 Aug 17. doi:10.3390/biomedicines11082287 

25. Hulscher N, Procter BC, Wynn C, McCullough PA. Clinical Approach to Post-acute Sequelae After COVID19 Infection and Vaccination. Cureus. 2023;15(11):e49204. Published 2023 Nov 21. doi:10.7759/cureus.49204 

26. Elecsys® Anti-SARS-CoV-2 S. Roche Diagnostics. Accessed August 5, 2024. https://diagnostics.roche.com/us/en/products/lab/elecsys-anti-sars-cov-2-s-cps-000616.html 

27. Komici K, Verderosa S, D'Amico F, Guerra G. Self-reported side effects following COVID-19 vaccination in athletes: A retrospective study. Hum Vaccin Immunother. 2023;19(2):2234788. doi:10.1080/21645515.2023.2234788 

28. Schwab C, Domke LM, Hartmann L, Stenzinger A, Longerich T, Schirmacher P. Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination. Clin Res Cardiol. 2023;112(3):431-440. doi:10.1007/s00392-022-02129-5 

29. Schmeling M, Manniche V, Hansen PR. Batch-dependent safety of the BNT162b2 mRNA COVID-19 vaccine. Eur J Clin Invest. 2023;53(8):e13998. doi:10.1111/eci.13998 

30. Fürst T, Å ourek P, Krátká Z, JanoÅ¡ek J. Batch-dependent safety of COVID-19 vaccines in the Czech Republic and comparison with data from Denmark. Eur J Clin Invest. Published online June 27, 2024. doi:10.1111/eci.14271 

31. Knoll F. How Bad is My Batch? [Online]. GitHub; 2024 [cited 2024 Aug 5]. Available at: https://knollfrank.github.io/HowBadIsMyBatch/HowBadIsMyBatch.html 

32. Sen G, Scully P, Gordon P, Sado D. Advances in the diagnosis of myocarditis in idiopathic inflammatory myopathies: an overview of diagnostic tests. Rheumatology (Oxford). 2024;63(7):1825-1836. doi:10.1093/rheumatology/keae029 

33. Silver MA, Maisel A, Yancy CW, et al. BNP Consensus Panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases [published correction appears in Congest Heart Fail. 2005 Mar-Apr;11(2):102]. Congest Heart Fail. 2004;10(5 Suppl 3):1-30. doi:10.1111/j.1527-5299.2004.03271.x 

34. McCullough PA, Olobatoke A, Vanhecke TE. Galectin-3: a novel blood test for the evaluation and management of patients with heart failure [published correction appears in Rev Cardiovasc Med. 2012;13(1):e52]. Rev Cardiovasc Med. 2011;12(4):200-210. doi:10.3909/ricm0624 

35. Bounds EJ, Kok SJ. D Dimer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 31, 2023. 

36. Patel, F., Roux, J.L., Sawry, S., Kieser, R., Dhar, M., Gill, K., Lazarus, E., Nana, A., Garrett, N., Moore, P.L., Sigal, A., Gray, G., Rees, H., Jacobson, B.F., & Fairlie, L. Clot Twist - D-dimer analysis of healthy adults receiving heterologous or homologous booster COVID-19 vaccine after a single prime dose of Ad26.COV2.S in a phase II randomised open-label trial, BaSiS. 2024. medRxiv. https://doi.org/10.1101/2024.02.19.24303026 

37. Ittiwut C, Mahasirimongkol S, Srisont S, et al. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022;19(11):1874-1879. doi:10.1016/j.hrthm.2022.07.019 

38. Maheshwari S, Dagor H. Evolving the Scope of Cardiac Point-of-Care Ultrasound in the Current Era. Cureus. 2024;16(2):e53985. Published 2024 Feb 10. doi:10.7759/cureus.53985 

39. Money DB, Mehio M, Scoma C, Gupta S. Cardiac Point-of-Care Ultrasound (P.O.C.U.S.) Utilization for Hospitalists in the Assessment of Patients with Cardiac Complaints: An Educational Overview. J Community Hosp Intern Med Perspect. 2023;13(4):1-8. Published 2023 Jun 29. doi:10.55729/2000-9666.1217 

40. Rajiah PS, François CJ, Leiner T. Cardiac MRI: State of the Art. Radiology. 2023;307(3):e223008. doi:10.1148/radiol.223008

41. Sen G, Scully P, Gordon P, Sado D. Advances in the diagnosis of myocarditis in idiopathic inflammatory myopathies: an overview of diagnostic tests. Rheumatology (Oxford). 2024;63(7):1825-1836. doi:10.1093/rheumatology/keae029 

42. Chan RH, Maron BJ, Olivotto I, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014;130(6):484-495. doi:10.1161/CIRCULATIONAHA.113.007094 

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Source: https://www.preprints.org/manuscript/202408.0821/v1

The Wellness Company's Base Spike Detox Trio


The first ever spike detox protocol appeared in the US Medical Literature and now it is available to you!

This base spike protein detox protocol consists of these three powerful ingredients: Spike Support's Nattokinase, Bromelain, and Tumeric Extract.

Vaccinated or not, prioritizing your well-being has never been more crucial.

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Note: Nattokinase and Bromelain are to be taken on an empty stomach, but Curcumin is with food.

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