Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week.

Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.

The importance of the DSM-IV E and F criteria in self-report assessments of PTSD.

The purpose of the current study was to examine the DSM-IV E and F criteria when using self-report measures of Posttraumatic Stress Disorder (PTSD). According to DSM-IV there are six core criteria required for a PTSD diagnosis including specific trauma characteristics, re-experiencing, avoidance, hyperarousal, duration, and impairment level. The Impact of Events Scale (IES) is a widely used self-report measure designed to measure PTSD symptoms. It has recently been suggested that the IES may produce misleading results, making emotional reactions to obviously non-traumatic events look like PTSD. In two separate studies, when duration (E criterion) and subjective impairment (F criterion) were included, the rates of those meeting PTSD criteria dropped from 20% to 3%. In addition, only 30% of events identified by a trauma history questionnaire met the DSM-IV definition of a traumatic event. The results have implications for the use of self-report measures in the assessment of PTSD.

PTSD symptoms and dominant emotional response to a traumatic event:an examination of DSM-IV Criterion A2.

To qualify for a diagnosis of posttraumatic stress disorder (PTSD), the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) requires that individuals report experiencing dominant emotions of fear, helplessness, and horror during the trauma (Criterion A2). Despite this stipulation, traumatic events can elicit a myriad of emotions other than fear, such as anger, guilt or shame, sadness, and numbing. The present study examined which emotional reactions to a stressful event in a college student sample are associated with the highest levels of PTSD symptoms. Our results suggest mixed support for the DSM-IV criteria. Although, participants who experienced a dominant emotion of fear reported relatively high PTSD symptomatology, participants who experience danger, disgust-related emotions, and sadness reported PTSD symptoms of equivalent severity. Additionally, participants reported dominant emotions of sadness and other emotions (including disgust, guilt, and shame) more frequently than they reported fear. These results question the specifics of diagnostic Criterion A2 and may have diagnostic and treatment implications.