Valsalva maneuver


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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.

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.

Val·sal·va ma·neu·ver

(vahl-sahl'vă), The phrase is ambiguous. The maneuver described by Valsalva for increasing pressure within the pharynx and reaerating the middle ear consists of forced expiratory effort with closed lips and nostrils. The maneuver generally employed in physical diagnosis to increase intrathoracic pressure consists of forced expiratory effort against the closed glottis, which does not affect pressure within the pharynx.
any forced expiratory effort ("strain") against a closed airway, whether at the nose and mouth or at the glottis, the reverse of Müller maneuver; because high intrathoracic pressure impedes venous return to the right atrium, this maneuver is used to study cardiovascular effects of raised peripheral venous pressure and decreased cardiac filling and cardiac output, as well as poststrain responses.

Valsalva maneuver

(văl-săl′və, väl-säl′vä)
n.
1. 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.
2. Expiratory effort against a closed glottis, which increases pressure within the thoracic cavity, causing decreased venous return of blood to the heart and a transient drop in blood pressure.

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

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

Val·sal·va ma·neu·ver

(vahl-sahl'vă mă-nū'vĕr)
Any forced expiratory effort ("strain") against a closed airway, whether at the nose and mouth or at the glottis; because high intrathoracic pressure impedes venous return to the right atrium, this maneuver is used to study cardiovascular effects of raised peripheral venous pressure and decreased cardiac filling and cardiac output.

Valsalva,

Antonio M., Italian anatomist, 1666-1723.
aneurysm of sinus of Valsalva - a congenital thin-walled tubular out-pouching usually in the right or noncoronary sinus with an entirely intracardiac course.
teniae of Valsalva - the three bands in which the longitudinal muscular fibers of the large intestine, except the rectum, are collected. Synonym(s): teniae coli
Valsalva antrum - a cavity in the petrous portion of the temporal bone. Synonym(s): mastoid antrum
Valsalva ligaments - the three ligaments that attach the auricle to the side of the head. Synonym(s): auricular ligaments
Valsalva maneuver - any forced expiratory effort against a closed airway.
Valsalva muscle - a band of vertical muscular fibers on the outer surface of the tragus of the ear. Synonym(s): tragicus muscle
Valsalva sinus - the space between the superior aspect of each cusp of the aortic valve and the dilated portion of the wall of the ascending aorta. Synonym(s): aortic sinus
Valsalva test - when the heart is monitored during the Valsalva maneuver, there is a characteristic complex sequence of cardiocirculatory events, departure from which indicates disease or malfunction.

Valsalva maneuver

a forcible expiratory effort in combination with a closed glottis as occurs in coughing.
References in periodicals archive ?
In particular the ultrasonic appearance of paratesticular hypo-anechoic dilated and convoluted structures with reflux during Valsalva maneuver led us to an initial incorrect diagnosis of varicocele.
However, some tears may not present themselves so readily, even following a Valsalva maneuver, and may only be realized postoperatively after many days, or even weeks of asymptomatic activity.
Figure 9c shows that at the beginning of the Valsalva maneuver (95 s), the typical blood pressure changes, which is not so clearly seen in other signals.
Intrathoracic pressure rise after isometric effort and Valsalva maneuver are identical-possible implications for divers with PFO.
Also, discuss the rationale for no coughing, nose-blowing, or Valsalva maneuver.
Avoidance of active pushing during labor by such patients has long been recommended because of theoretical concerns that the reduction in preload and increased myocardial oxygen requirement that occur with the Valsalva maneuver place women with congenital heart disease at increased risk for cardiac events.
The chest pressure is maintained as the victim holds their breath (similar to a Valsalva maneuver achieved by exhaling against a partially closed glottis) until they pass out.
Diagnosis of CAN was based on the Valsalva maneuver, beat-to-beat variability during periods of inspiration and expiration, blood pressure responses to standing, and heart rate.
2006): Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva maneuver.
In achalasia, Valsalva maneuver might accompany severe vomiting.
In addition, the patient had decreased bladder and rectal tone, and could not perform the Valsalva maneuver.