Standing and Exercise Doppler Echocardiography in Obstructive Hypertrophic Cardiomyopathy: The Range of Gradients with Upright Activity

Although standing increased gradients by 76%, it is not as potent a provocative maneuver as Valsalva or treadmill exercise. Nevertheless, standing is recommended as a physiologic provocative maneuver. In some patients standing may guide therapy; in others, the standing and exercise gradient provide a correct appreciation of the range of physiologically experienced gradients during daily upright activity.