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Letter to the Editor

Considerations on the Diagnosis and Prognosis of Primary Cardiac Lymphoma

Thalisson Gonçalves Almeida et al. Tales Gabriel Ferro de Oliveira Gustavo da Silva Soares Pedro Pereira Tenório

Dear Editor,

We would like to congratulate the authors on their relevant case report, “Cardiac Lymphoma: A Case Report,” published in the Arquivos Brasileiros de Cardiologia (ABC Cardiol). The article addresses a rare and challenging clinical condition, primary cardiac lymphoma (PCL), which, as highlighted in the article, is an aggressive tumor with a poor prognosis and nonspecific symptoms, making early diagnosis difficult. Among the article’s strengths, we highlight the rarity of the case, as it is a diffuse large B-cell lymphoma (DLBCL) with primary cardiac involvement, given the low incidence of these tumors (approximately 0.04% of primary malignant cardiac tumors, with lymphomas representing about 1.3% of these), with DLBCL being the most common subtype, frequently located in the right chambers of the heart.^,

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IJCS

Editorial

Anxiety, Depression, Stress and the Heart: When Measurement Matters

Cristiano Tschiedel Belem da Silva et al. Rafaela Doebber Escobar

The interplay between cardiovascular symptoms and stress has been a matter of concern for centuries. The first known scientific description of panic disorder, for example, which would nowadays be considered a mixture of panic disorder itself, post-traumatic-stress disorder, cardiac arrhythmia and congestive heart failure, took place in a cohort of three hundred patients of a military hospital in Philadelphia (USA). The name of the new diagnostic entity that followed (“irritable heart syndrome” or simply “Da Costa Syndrome,” named after the author of the original description) is rather an indicator of the historical overlap between cardiovascular diseases (CVD) and psychosocial conditions than properly an example of scientific rigor in describing the discovery of a new medical syndrome.

About sixteen years after the description of the irritable heart syndrome, Augustus Waller, a British physiologist, published the first human electrocardiogram (EKG) applying a capillary electrometer and placing electrodes in the chest and back of an individual. More than half a century after Waller’s publication, the 12-Lead EKG – as we know it now – was standardized by the American Heart Association. Since then, EKG is the most important test for the interpretation of cardiac rhythm and for the detection of myocardial ischemia. In sharp contrast with diagnostic developments in Cardiology and despite a whole new era in neuroimaging, no single physiological marker has emerged to help detecting anxiety disorders or depression in Psychiatry. Nonetheless, the degree to which mental disorders are realized within the brain or in the rest of the body is still unclear.

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ABC

Artigo Original

Prenatal study of fetal endocardial hyperrefringence and its relation to maternal toxoplasmosis

Luiz Henrique Soares Nicoloso et al. Tiene Zingano Henke Paulo Zielinsky

OBJECTIVE: To compare a group of fetuses whose mothers had acute or recent toxoplasmosis with a group of fetuses whose mothers had no systemic disease, analyzing the presence of changes in endocardial refringence. METHODS: This study assessed 91 fetuses of mothers diagnosed with acute or recent toxoplasmosis, detected by seroconversion or the presence of elevated IgM and IgG titers, confirmed through the IgM-capture ELISA. They were compared with a control group comprising 182 fetuses selected from a low-risk population participating in a prenatal screening program for heart diseases. RESULTS: No significant difference was observed between the mean gestational (29.2±4.6 weeks; 29.2±4.6 weeks) and maternal (25.7±6.7 years; 26±5.4 years) ages in the 2 groups. Areas of endocardial hyperechogenicity were observed in 69 fetuses whose mothers had toxoplasmosis (75.8%) and in only 6 fetuses of the control group (3.3%) (P<0.001). In 52 patients of the group studied (75.4%), endocardial hyperrefringence was diffuse, and, in 17 (24.3%), it was focal. In the control group, focal distribution was observed in 5 fetuses (83.3%). CONCLUSION: The prenatal echocardiographic image of focal or diffuse endocardial hyperrefringence is more prevalent in pregnancies with maternal toxoplasmosis than in the healthy ones, and an association between fetal endocardial hyperechogenicity and maternal disease exists.

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Considerations on the Diagnosis and Prognosis of Primary Cardiac Lymphoma

Anxiety, Depression, Stress and the Heart: When Measurement Matters

Prenatal study of fetal endocardial hyperrefringence and its relation to maternal toxoplasmosis

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