Despite increasing prevalence in critical care units, cardiogenic shock related to HF (HF-CS) is incompletely understood and distinct from acute myocardial infarction related CS. This review highlights the pathophysiology, evaluation, and contemporary management of HF-CS.

Background: Since coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019, the number of cases has risen exponentially. Clinical characteristics and outcomes among patients with orthotopic heart transplant (OHT) with COVID-19 remain poorly described. Methods: We performed a retrospective case series of patients with OHT with COVID-19 admitted to 1 of 2 hospitals in Southeastern Michigan between March 21 and April 22, 2020. Clinical data were obtained through review of the electronic medical record. Final date of follow-up was May 7, 2020. Demographic, clinical, laboratory, radiologic, treatment, and mortality data were collected and analyzed. Results: We identified 13 patients with OHT admitted with COVID-19. The mean age of patients was 61 § 12 years, 100% were black males, and symptoms began 6 § 4 days before admission. The most common symptoms included subjective fever (92%), shortness of breath (85%), and cough (77%). Six patients (46%) required admission to the intensive care unit. Two patients (15%) died during hospitalization. Conclusions: Black men may be at increased risk for COVID-19 among patients with OHT. Presenting signs and symptoms in this cohort are similar to those in the general population. Elevated inflammatory markers on presentation appear to be associated with more severe illness.

P rolonged use of hydroxychloroquine (HCQ) has been implicated in the development of conduction disturbances and myocardial dysfunction. 1 We report a case of cardiomyopathy after 10 years of HCQ therapy in a 66-yearold woman with systemic lupus erythematosus (SLE). Case PresentationA 66-year-old white woman with a 24-year history of SLE presented to our institution with decompensated heart failure. She had no cardiac history until 8 weeks before admission, when she presented to an outside hospital for new-onset heart failure. Other significant medical history included gout, dyslipidemia, hypertension, and SLE first diagnosed in 1986 complicated by World Health Organization class 4 lupus nephritis, diagnosed in 2001. She was taking HCQ (400 mg daily), prednisone (Ͻ5 mg/d), and azathioprine for treatment of SLE. The evaluation for new-onset heart failure at the outside facility consisted of an echocardiogram, which showed a left ventricular ejection fraction of 35% and coronary angiogram that revealed mild, nonobstructive coronary artery disease. The ECG showed new-onset, 3rd-degree atrioventricular block. She underwent placement of a biven-

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