Valsalva Maneuver
maneuver /ma·neu·ver/ (mah-noo´ver) a skillful or dextrous method or procedure.
Valsalva maneuver
Valsalva maneuver [val-sal´vah]
Valsalva maneuver
Definition
The Valsalva maneuver is performed by attempting to forcibly exhale while keeping the mouth and nose closed. It is used as a diagnostic tool to evaluate the condition of the heart and is sometimes done as a treatment to correct abnormal heart rhythms or relieve chest pain.
Purpose
The Valsalva maneuver is used with patients who have suspected heart abnormalities, often in conjunction with echocardiography. The maneuver is based on the fact that when a patient forcibly exhales against a closed nose and mouth while bearing down, as if having a bowel movement, specific changes occur in blood pressure and the rate and volume of blood returning to the heart.
Comparing the changes in a diseased heart to those expected in a normal heart gives clues to the type and location of heart damage. In addition, when a doctor listens to the chest with a stethoscope during the Valsalva maneuver, characteristic heart sounds are heard. Variations in these sounds can indicate the type of abnormality present in the heart. A 2004 study found that blood pressure response to the Valsalva maneuver could predict mortality in elderly patients with congestive heart failure. This could prove to be a new noninvasive way to help determine how long elderly patients with congestive heart failure are expected to live.
The Valsalva maneuver also corrects some rapid heartbeats originating in the atria. When the maneuver is done correctly, blood pressure rises. This forces the heart to respond by correcting its rhythm and beating more slowly. On rare occasions, the Valsalva maneuver can be used to diminish chest pain in patients with mild coronary disease.
Unrelated to any evaluation of the heart, the Valsalva maneuver also is taught to patients with multiple sclerosis who are unable to fully empty the bladder (flaccid bladder). It sometimes is used in sexual therapy to help men avoid premature ejaculation.
Precautions
The Valsalva maneuver should not be performed by patients who have severe coronary artery disease, have experienced recent heart attack, or have a moderate to severe reduction in blood volume.
Description
When performed formally, the patient is asked to blow against an aneroid pressure measuring device (manometer) and maintain a pressure of 40 millimeters of mercury (mm Hg) for 30 seconds. Or, less formally, the patient may be asked to bear down, as if having a bowel movement. During this 30 second period, a recording is made of the changes in blood pressure and murmurs of the heart.
Preparation
The patient may be connected to a heart monitor and echocardiograph or the physician may simply use a stethoscope to monitor the heart. Sometimes an indwelling needle is inserted for accurate pressure measurements, depending on whether the procedure is being done for corrective or diagnostic purposes.
Aftercare
When this procedure is done to regulate irregular heart rhythms, the patient usually remains on a heart monitor to evaluate heartbeat.
Risks
The patient may feel dizzy or faint during the procedure, but serious consequences are rare. There is a risk that the Valsalva maneuver can cause blood clots to detach, bleeding, and abnormal rhythms originating in the ventricle. It can also cause cardiac arrest. Consequently, the procedure is usually performed in a setting where emergency equipment is accessible.
Normal results
There are four characteristic changes or phases in a normal heart's response to the Valsalva maneuver. An abnormality in any of these phases indicates a cardiovascular abnormality.
Resources
Periodicals
Jancin, Bruce. "New Mortality Predictor Found for Heart Failure." Family Practice News March 15, 2004: 48-49.
Key terms
Atria — The heart has four chambers. The right and left atria are at the top of the heart and receive returning blood from the veins. The right and left ventricles are at the bottom of the heart and act as the body's main pumps.
Echocardiography — An ultrasound test that shows the size, shape, and movement of the heart.
maneuver /ma·neu·ver/ (mah-noo´ver) a skillful or dextrous method or procedure.
Bracht's maneuver a method of extraction of the aftercoming head in breech presentation.
Brandt-Andrews maneuver a method of expressing the placenta from the uterus.
forward-bending maneuver a method of detecting retraction signs in neoplastic changes in the mammae; the patient bends forward from the waist with chin held up and arms extended toward the examiner. If retraction is present, an asymmetry in the breast is seen.
Heimlich maneuver a method of dislodging food or other material from the throat of a choking victim: wrap one's arms around the victim, allowing their upper torso to hang forward; with both hands against the victim's abdomen (slightly above the navel and below the rib cage), make a fist with one hand, grasp it with the other, and forcefully press into the abdomen with a quick upward thrust. Repeat several times if necessary. 
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Heimlich maneuver.
Pajot's maneuver a method of forceps delivery with traction along the axis of the superior pelvic aperture.
Pinard's maneuver a method of bringing down the foot in breech extraction.
Prague maneuver a method of extracting the aftercoming head in breech presentation.
Scanzoni maneuver double application of forceps blades for delivery of a fetus in the occiput posterior position.
Toynbee maneuver pinching the nostrils and swallowing; if the auditory tube is patent, the tympanic membrane will retract medially.
Valsalva maneuver
1. increase in intrathoracic pressure by forcible exhalation effort against the closed glottis.
2. increase in the pressure in the eustachian tube and middle ear by forcible exhalation effort against occluded nostrils and closed mouth.
Val·sal·va maneuver (v l-sl v )n. 1. Expiratory effort against a closed glottis, which increases pressure within the thoracic cavity and thereby impedes venous return of blood to the heart. The maneuver results in changes in blood pressure and heart rate and is used in conjunction with other tests to diagnose cardiac abnormalities and to treat various conditions, especially some abnormal heart rhythms. 2. Expiratory effort when the mouth is closed and the nostrils are pinched shut, which forces air into the eustachian tubes and increases pressure on the inside of the eardrum. |
Valsalva maneuver
[valsal′və]
Etymology: Antonio M. Valsalva, Italian surgeon, 1666-1723; OFr, maneuvre, work done by hand
any forced expiratory effort against a closed airway, such as when an individual holds the breath and tightens the muscles in a concerted, strenuous effort to move a heavy object. Most healthy individuals perform Valsalva maneuvers during normal daily activities without any injurious consequences. However, such efforts are dangerous for many patients with cardiovascular disease, especially if they become dehydrated, increasing the viscosity of their blood and the attendant risk of blood clotting. Constipation increases the risk of cardiovascular trauma in such patients, especially if they perform a Valsalva maneuver in trying to move their bowels. On relaxation after each muscular effort with held breath, the blood of such individuals rushes to the heart, often overloading the cardiac system and causing cardiac arrest. Orthopedic patients often use a Valsalva maneuver in changing their position in bed with the aid of an overhead trapeze bar. Patients who may be endangered by performing a Valsalva maneuver are commonly instructed to exhale instead of holding their breath when they move. Exhalation decreases the risk of cardiovascular trauma. Part of danger is bradycardia response.
Valsalva maneuver [val-sal´vah]
1. increase of intrathoracic pressure by forcible exhalation against the closed glottis; this maneuver causes trapping of blood in the great veins, preventing it from entering the chest and right atrium. When the breath is released, the intrathoracic pressure drops and the trapped blood is quickly propelled through the heart, producing tachycardia (increased heart rate) and a rise in blood pressure; this is followed almost immediately by a reflex bradycardia. The Valsalva maneuver occurs when one strains to defecate and urinate, uses the arms and upper trunk muscles to move up in bed, or strains during coughing, gagging, or vomiting. The increased pressure, immediate tachycardia, and reflex bradycardia can bring about cardiac arrest in vulnerable heart patients.
2. increase in the pressure in the eustachian tube and middle ear by forcible exhalation against closed nostrils and mouth.
Valsalva maneuver
a forcible expiratory effort in combination with a closed glottis as occurs in coughing.
Valsalva maneuver
Forced expiration against a closed glottis after full inspiration, described by Valsalva in 1704 to expulse pus from the middle ear; the 'Valsalva' ↑ intrathoracic pressure for ±10 secs,
eliciting a complex series of changes in pulse rate and BP involving both vagal and sympathetic responses
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