Takotsubo Cardiomyopathy Associated with Acute COVID-19 Pneumonia.

Cardiogenic shock carries a high burden of morbidity and mortality because of inadequate tissue perfusion leading to end-stage multi-organ damage. The initial work-up includes a pertinent and thorough history and physical examination to identify possible cardiac and noncardiac etiologies. The following case describes a patient presenting with symptomatic acute COVID-19 (SARS-CoV-2) pneumonia with initial findings consistent with cardiogenic shock. SARS-CoV-2 pneumonia has been associated with multiple cardiac manifestations including myocarditis, heart failure, myocardial infarction, and Takotsubo cardiomyopathy. This patient was treated with conservative medical management and had complete clinical recovery and normal cardiac angiography weeks after their initial presentation. This clinical scenario highlights the significance of a broad differential and extensive work-up when faced with a patient presenting with cardiogenic shock.

Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints.

Objectives: To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT-MH), (2) the correlation among CAT-MH scores and self- and clinician-reported assessments, and (3) the association between CAT-MH scores and ED utilization in the year prior and 30 days after enrollment. Methods: This was a single-center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer-adaptive-assessed domains of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results: From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT-MH domains were highly correlated with self-report assessments (r = 0.49-0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate-high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07-2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate-high-suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion: The CAT-MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.