Eighty-seven patients with the clinical syndrome of infective endocarditis were examined by M-mode and two-dimensional echocardiography. Patients were divided into two groups based on the presence or absence of echocardiographically detected vegetative lesions. Group 1 consisted of 47 patients with one or more vegetations. Group 2 consisted of 40 patients without evidence of vegetations. Group 1 patients had a higher rate of complications: emboli, congestive heart failure and the need for surgical intervention. Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. Two-thirds of the vegetations persisted unaltered well beyond the period of bacteriologic cure without significant complications. No characteristic alteration of the vegetations predicted the efficacy of medical therapy. Although the detection of vegetations by echocardiography in patients with the clinical syndrome of endocarditis clearly identifies a subgroup at risk for complications, decisions regarding clinical management made solely on the basis of the presence or absence of vegetative lesions are hazardous. Management of such patients must continue to be based on the clinical integration of multiple factors.

Summary:A 30-year-old female with a history of surgically treated osteosarcoma 2 years prior to admission presented with progressive dyspnea and cyanosis. Physical examination was otherwise negative. Cardiac catheterization demonstrated a right ventricular mass lesion. At surgery, a metastatic osteosarcoma filling the entire right ventricle and extending from the pulmonary valve across the tricuspid valve and into the right atrial cavity was partially excised. Despite marked improvement postoperatively, she died 33 dafter surgery. Postmortem findings were unusual in that the heart represented the sole site of metastasis. The diagnostic approach to cardiac symptoms from malignancy is discussed in relation to this patient.

One hundred seventy adult patients with possible congenital or valvular heart disease underwent contrast two-dimensional echocardiographic examination as part of a precatheterization evaluation. Persistent left superior vena cava was detected in 5 patients, each of whom demonstrated an abnormally large coronary sinus. Injection of echocardiographic contrast material from a peripheral left arm vein resulted in early opacification of this structure before other right-side chambers, thus suggesting abnormal venous drainage. Persistent left superior vena cava was confirmed in all 5 patients at the time of catheterization and/or surgery.

SUMMARY Contrast M-mode and two-dimensional ultrasonography of the inferior vena cava were performed in 65 patients with various acquired and congenital cardiac disorders. After saline was injected into a peripheral arm vein, the inferior vena cava was visualized by both methods in 60 patients (92%). The M-mode approach was better for correlating the appearance of contrast within the inferior vena cava with the ECG. This precise correlation served as the basis for differentiating patients with tricuspid insufficiency (visualization of contrast after the QRS) from those with impaired right ventricular filling (visualization of contrast before the QRS) or arrhythmia. Results with the M-mode approach suggest that conditions other than tricuspid insufficiency may cause the appearance of contrast within the inferior vena cava. M-mode echocardiography should be used to further investigate patients with impaired right ventricular filling.CONTRAST ECHOCARDIOGRAPHY is a useful technique for verifying cardiac anatomic structure, evaluating intracardiac shunts and detecting valvular insufficiency.' 10 Lieppe et al."1 showed that twodimensional echocardiography is a sensitive technique for detecting tricuspid regurgitation by visualizing within the inferior vena cava contrast that was injected peripherally. The major advantages of the twodimensional approach are spatial anatomic identification of the inferior vena cava and recognition of the direction in which contrast moved within this vessel.Clinical experience with ultrasonography of the vena cava leads us to believe that conditions other than tricuspid insufficiency cause the appearance of the contrast within this vessel. These may not be readily apparent if the two-dimensional approach alone is used. Two-dimensional echocardiography suffers from time-domain sampling rates restricted to television frame rates (30 frames/sec). Such low sampling rates make it difficult to time precisely the appearance of contrast in relation to the cardiac cycle.The higher time-domain sampling rates of M-mode (1,000 or more samples/sec) displayed on the familiar strip-chart recording make it quite easy to relate the time of contrast appearance to the ECG. The present study addressed the hypotheses that M-mode echocardiography is a useful alternative to the twodimensional approach for detecting contrast within the inferior vena cava, and for purposes of obtaining critical timing information, M-mode ultrasonography is superior.

PURPOSE: The purpose of this study was to examine the effectiveness of high-intensity interval training (HIIT) style warm-up on hemodynamic, power, and flexibility responses. METHODS: Twelve male subjects (age: 24.15 ± 3.1 yr. & weight: 78.78 ± 16.83 kg) completed the study. On the first day, initial screening, anthropometric measures, and familiarization with testing procedures were completed. There were a total of 6 randomized testing sessions (separated by at least 48 hours.). The testing sessions were as follows: 3-min warm-up session with 20 sec work followed by 10 sec (C1), 3-min warm-up session with 30 sec work followed by 10 sec (C2), 5-min warm-up session with 20 sec work followed by 10 sec (C3), 5-min warm-up session with 30 sec work followed by 10 sec (C4), 8-min warm-up session with 20 sec work followed by 10 sec (C5), and 8-min warm-up session with 30 sec work followed by 10 sec (C6). The warmup sessions included timed interval body weight squats. Hemodynamics (heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure), a countermovement jump, and flexibility values were recorded before and after warm-up protocols. RESULTS: There was a significant duration*time interaction for flexibility (p<0.01) and vertical jump (p=0.02). Flexibility increased from pre to post for 3-min and 5-min warm-up conditions, however, decreased for 8-min warm-up conditions. Vertical jump increased for 3min conditions and decreased for 5-min and 8-min conditions. There were significant duration main effects for HR (p<0.03); time main effects for HR (p<0.01), SBP (p<0.01), and DBP (p<0.01); duration*time interaction for HR (p<0.01) and intensity*time interaction for SBP (p<0.04). CONCLUSION: The findings of the study indicate that a 3-min duration of HIIT style warm-up may be enough to physically prepare individuals to improve flexibility and vertical jump. In addition, the data also suggests that the required/recommended duration for the warm-up to prepare body may be shortened with HIIT style warm-up. Future studies should compare and contrast the efficacy of varying work to rest ratio of HIIT style warm-up with other warm-up protocols to determine the most effective warm-up protocol.