The Valsalva Upgrade: How Goal-Directed Testing Changes HCM Diagnosis

This episode of Sonographers After Dark was sponsored by the American Society for Echocardiography, with support from an unrestricted educational grant from Bristol Myers Squibb. In this episode, Lara Williams sits down with Margaret Kurnides, ACS, RDCS, FASE, and Amy Dillenbeck, MS, ACS, RDCS, RCS, FASE to discuss the growing adoption of goal-directed Valsalva in echocardiography and why it is transforming how sonographers evaluate patients with hypertrophic cardiomyopathy (HCM). The conversation explores how the traditional Valsalva maneuver often varies between sonographers, leading to inconsistent results. By contrast, the goal-directed approach creates a standardized and reproducible maneuver that can reliably unmask latent LVOT obstruction, which may be present in up to one-third of HCM patients who show no obstruction at rest. Margaret and Amy share practical insights from implementing the technique in clinical labs, including setup tips, infection-control considerations, and strategies for gaining physician and administrative buy-in. They also discuss imaging challenges, differentiating LVOT signals from mitral regurgitation, and the importance of correlating Doppler findings with the broader physiologic picture. The discussion takes on new urgency in the era of myosin inhibitor therapies, where accurate echocardiographic measurements—particularly LVOT gradients and ejection fraction—are critical for diagnosis, treatment selection, and medication titration. The group emphasizes why sonographers must understand the physiology behind HCM, not just the imaging protocol. The episode closes with a look at upcoming ASE micro-lessons on goal-directed Valsalva. If you scan echo—or teach it—this is a conversation about technique, physiology, and the evolving role of the sonographer in modern HCM care. #sonographersafterdark #iheartecho #allaboutultrasound #loveecho #loveultrasound #bettercardiology #echoquality #cardiacultrasound #hocm #hypertrophiccardiomyopathy #hcm #goaldirectedvalsalva