Risk stratification for future cardiac arrest after COVID-19 vaccination

Figure 1 Coronavirus disease 2019 vaccine-induced cardiac arrest. NSR: Normal sinus rhythm; VT: Ventricular tachycardia; VF: Ventricular fibrillation; BNP/NT-proBNP: Brain natriuretic peptide and N-terminal proBNP (Created in BioRender, Supplementary material).

Figure 2 Risk stratification approach for future cardiac arrest after coronavirus disease 2019 vaccination. Green boxes indicate clinical features, test results, and patients at lower risk. Red and pink boxes show tests and results indicating higher risk. Hx: History; AU/mL: Antibody units per milliliter; HR: Heart rate; BP: Blood pressure; ECG: Electrocardiogram; Hs-troponin: High-sensitivity troponin; BNP/NT-proBNP: Brain natriuretic peptide and N-terminal proBNP; LVEF: Left ventricular ejection fraction; POTS: Postural orthostatic tachycardia syndrome (Created in BioRender, Supplementary material).

Figure 3 McCullough protocol: Base spike detoxification. A: Dissolution of spike protein-induced 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 nuclear factor kappa B signaling pathway induced by spike protein, leading to the suppression of inflammatory molecules; E: Base spike detoxification treatment protocol. The full treatment regimen and the addition of other compounds based on clinical indication are illustrated. 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. Citation: Hulscher N, Procter BC, Wynn C, McCullough PA. Clinical Approach to Post-acute Sequelae After COVID-19 Infection and Vaccination. Cureus 2023; 15(11): e49204 Copyright ©The Author(s) 2023. Published by Springer Nature[25] (Supplementary material).