{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:30:12Z","timestamp":1773927012639,"version":"3.50.1"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T00:00:00Z","timestamp":1551398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T00:00:00Z","timestamp":1551398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Echo Res Pract"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>A 70-year-old female with exertional dyspnoea was found to have basal septal hypertrophy (BSH), or a \u2018basal septal bulge\u2019, with evidence of mild left ventricular outflow tract obstruction (LVOT) at rest on her initial echocardiogram. She was usually fit and well with no significant past medical history. She had no history of hypertension. She had never smoked. There was no family history of hypertrophic cardiomyopathy (HCM). A cardiac MRI did not demonstrate any typical features of HCM. ECG showed sinus tachycardia with a rate of 101\u2009bpm but was otherwise unremarkable. She was referred for exercise echocardiography to assess for latent LVOT obstruction. Prior to commencing exercise, her LVOT gradient was re-assessed at rest. Her LVOT gradients were 30\u2009mmHg at rest, 49\u2009mmHg during Valsalva and 91\u2009mmHg on standing. A diagnosis of significant latent LVOT obstruction was made and the patient was started on bisoprolol, a cardioselective beta-blocker. Bisoprolol was slowly uptitrated from 1.25\u2009mg to 5\u2009mg once daily, following which the patient reported a significant improvement in her symptoms with an improved exercise capacity. Follow-up echocardiography demonstrated a dramatic reduction in LVOT gradient, with a maximum of 11\u2009mmHg assessed both with Valsalva and on standing. This case is a reminder that patients with a \u2018common\u2019 basal septal bulge can develop significant LVOT obstruction, the symptoms of which may respond to pharmacological therapy. Orthostatic assessment of LVOT gradient using echocardiography should be considered during standard LVOT obstruction provocation manoeuvres such as a Valsalva.<\/jats:p>","DOI":"10.1530\/erp-18-0072","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T18:01:08Z","timestamp":1548180068000},"page":"K1-K6","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Routine orthostatic LVOT gradient assessment in patients with basal septal hypertrophy and LVOT flow acceleration at rest: please stand up"],"prefix":"10.1186","volume":"6","author":[{"given":"H. C.","family":"Sinclair","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Russhard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. H.","family":"Critoph","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. D.","family":"Steadman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,3,1]]},"reference":[{"key":"601007_CR1","doi-asserted-by":"publisher","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu283","volume":"35","author":"PM Elliott","year":"2014","unstructured":"Authors\/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). European Heart Journal 2014 35 2733\u20132779. (https:\/\/doi.org\/10.1093\/eurheartj\/ehu284)","journal-title":"European Heart Journal"},{"key":"601007_CR2","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1136\/heartjnl-2015-308764","volume":"102","author":"M Canepa","year":"2016","unstructured":"Canepa M, Pozios I, Vianello PF, Ameri P, Brunelli C, Ferrucci L, Abraham TP. Distinguishing ventricular septal bulge versus hypertrophic cardiomyopathy in the elderly. Heart 2016 102 1087\u20131094. (https:\/\/doi.org\/10.1136\/heartjnl-2015-308764)","journal-title":"Heart"},{"key":"601007_CR3","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/j.hlc.2011.05.002","volume":"20","author":"I Ranasinghe","year":"2011","unstructured":"Ranasinghe I, Yeoh T, Yiannikas J. Negative ionotropic agents for the treatment of left ventricular outflow tract obstruction due to sigmoid septum and concentric left ventricular hypertrophy. Heart, Lung and Circulation 2011 20 579\u201386. (https:\/\/doi.org\/10.1016\/j.hlc.2011.05.002)","journal-title":"Heart, Lung and Circulation"},{"key":"601007_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/openhrt-2014-000176","volume":"1","author":"CH Critoph","year":"2014","unstructured":"Critoph CH, Pantazis A, Tome Esteban MT, Salazar-Mendiguch\u00eda J, Pagourelias ED, Moon JC, Elliott PM. The influence of aortoseptal angulation on provocable left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Open Heart 2014 1 1\u20138. (https:\/\/doi.org\/10.1136\/openhrt-2014-000176)","journal-title":"Open Heart"},{"key":"601007_CR5","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1136\/hrt.2007.126003","volume":"94","author":"JS Shah","year":"2008","unstructured":"Shah JS, Esteban T, Thaman R, Sharma R, Mist B, Pantazis A, Ward D, Kohli SK, Page SP, Demetrescu C, et al. Prevalence of exercise induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy. Heart 2008 94 1288\u20131294. (https:\/\/doi.org\/10.1136\/hrt.2007.126003)","journal-title":"Heart"},{"key":"601007_CR6","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1136\/hrt.61.6.506","volume":"61","author":"H Kelbaek","year":"1989","unstructured":"Kelbaek H, Munck O, Christensen NJ, Godtfredsen J. Central haemodynamic changes after a meal. British Heart Journal 1989 61 506\u2013509. (https:\/\/doi.org\/10.1136\/hrt.61.6.506)","journal-title":"British Heart Journal"},{"key":"601007_CR7","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1016\/j.jacc.2013.02.079","volume":"61","author":"E Feiner","year":"2013","unstructured":"Feiner E, Arabadjian M, Winson G, Kim B, Chaudhry F, Sherrid MV. Post-prandial upright exercise echocardiography in hypertrophic cardiomyopathy. Journal of the American College of Cardiology 2013 61 2487\u20132488. (https:\/\/doi.org\/10.1016\/j.jacc.2013.02.079)","journal-title":"Journal of the American College of Cardiology"},{"key":"601007_CR8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.echo.2010.10.006","volume":"24","author":"S Joshi","year":"2011","unstructured":"Joshi S, Patel UK, Yao SS, Castenada V, Isambert A, Winson G, Chaudhry FA, Sherrid MV. Standing and exercise doppler echocardiography in obstructive hypertrophic cardiomyopathy: the range of gradients with upright activity. Journal of the American Society of Echocardiography 2011 24 75\u201382. (https:\/\/doi.org\/10.1016\/j.echo.2010.10.006)","journal-title":"Journal of the American Society of Echocardiography"},{"key":"601007_CR9","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/1476-7120-6-19","volume":"6","author":"R Miranda","year":"2008","unstructured":"Miranda R, Cotrim C, Cardim N, Almeida S, Lopes L, Loureiro MJ, Sim\u00f5es O, Cordeiro P, Fazendas P, Jo\u00e3o I, et al. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy. Cardiovascular Ultrasound 2008 6 19. (https:\/\/doi.org\/10.1186\/1476-7120-6-19)","journal-title":"Cardiovascular Ultrasound"}],"container-title":["Echo Research &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1530\/ERP-18-0072\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1530\/ERP-18-0072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1530\/ERP-18-0072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T02:09:11Z","timestamp":1650593351000},"score":1,"resource":{"primary":{"URL":"https:\/\/echo.biomedcentral.com\/articles\/10.1530\/ERP-18-0072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["601007"],"URL":"https:\/\/doi.org\/10.1530\/erp-18-0072","relation":{},"ISSN":["2055-0464"],"issn-type":[{"value":"2055-0464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3]]},"assertion":[{"value":"10 December 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 March 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}