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At least 19 recordsLinked to original sources
PubMed2004

Reciprocal splanchnic-thoracic blood volume changes during the Valsalva maneuver.

The Valsalva maneuver is frequently used to test autonomic function. Previous work demonstrated that the blood pressure decrease during the Valsalva maneuver relates to thoracic hypovolemia, which may preclude pressure recovery during phase II, even with normal resting peripheral vasoconstriction. We hypothesized that increased regional blood volume, specifically splanchnic hypervolemia, accounts for the degree of thoracic hypovolemia during the Valsalva maneuver. We studied 17 healthy volunteers aged 15-22 yr. All had normal blood volumes by dye dilution. Subjects also had normal vascular resistance while supine as well as normal vasoconstrictor responses during 35 degrees upright tilt. We assessed changes in estimated splanchnic, pelvic-thigh, and lower leg blood volume, along with thoracic blood volume shifts, by impedance plethysmography before and during the Valsalva maneuver performed in the supine position. Early increases in splanchnic blood volume dominated the regional vascular changes during the Valsalva maneuver. The increase in splanchnic blood volume correlated well (r2 = 0.65, P < 0.00001) with the decrease in thoracic blood volume, there was less correlation of the increase in pelvic blood volume (r2 = 0.21, P < 0.03), and there was no correlation of the increase in leg blood volume (r2 = 0.001, P = 0.9). There was no relation of thoracic hypovolemia with blood volume or peripheral resistance in supine or upright positions. Thoracic hypovolemia during the Valsalva maneuver is closely related to splanchnic hyperemia and weakly related to regional changes in blood volume elsewhere. Changes in baseline splanchnic vascular properties may account for variability in thoracic blood volume changes during the Valsalva maneuver.

Adolescent↗
PubMed1990

[Clinical use of the Valsalva maneuver].

The Valsalva maneuver (VM) is a widely used test for autonomic nervous system function. It consists of a physiologic effort which is often performed in everyday life. Extreme effort may cause faintness or fainting, even in normal persons. The VM can help the physician manage loss of consciousness of unknown cause. Because of similarity of the effect of VM to that of hyperventilation on the cerebral circulation we suggest wider application of this maneuver in clinical electroencephalography.

Autonomic Nervous System↗
PubMed1999

Critical closing pressure explains cerebral hemodynamics during the Valsalva maneuver.

The Valsalva maneuver (VM), a voluntary increase in intrathoracic pressure of approximately 40 mmHg, has been used to examine cerebral autoregulation (CA). During phase IV of the VM there are pronounced changes in mean arterial blood pressure (MABP), pulse interval, and cerebral blood flow (CBF), but the changes in CBF are of a much greater magnitude than those seen in MABP, a finding to date attributed to either a delay in activation of the CA mechanism or the inability of this mechanism to cope with the size and speed of the blood pressure changes involved. These changes in CBF also precede those in MABP, a pattern of events not explained by the physiological process of CA. Measurements of CBF velocity (transcranial Doppler) and MABP (Finapres) were performed in 53 healthy volunteers (aged 31-80 yr). By calculating beat-to-beat values of critical closing pressure (CCP) during the VM, we have found that this parameter suddenly drops at the start of phase IV, providing a coherent explanation for the large increase in CBF. If CCP is included in the estimation of cerebrovascular resistance, a temporal pattern more consistent with an autoregulatory response to the MABP overshoot is also found. CCP is intricately involved in the control of CBF during the VM and should be considered in the assessment of CA.

Adult↗
PubMed2004

Effects of thoracic blood volume on Valsalva maneuver.

The Valsalva maneuver (VM) is frequently used to test autonomic function. However, the VM is also affected by changes in blood volume and blood volume redistribution. We hypothesized that even a standardized VM may produce a wide range of thoracic blood volume shifts. Larger blood volume shifts in some normovolemic individuals may be sufficient to induce decreases in blood pressure (BP) that preclude autonomic restoration of BP in phase II of the VM. To test this hypothesis, we studied 17 healthy volunteers aged 15-22 yr. All had similar vasoconstrictor responses when supine and upright and normal blood volume measurements. We assessed changes in thoracic blood volume by impedance plethysmography before and during the VM performed while subjects were supine. In some subjects, large decreases in BP were produced by thoracic hypovolemia. The maximum fractional decrease in BP correlated well (r(2) = 0.64; P < 0.001) with thoracic hypovolemia and with systolic BP at the end of phase II of the VM (r(2) = 0.67; P < 0.001). The BP overshoot in phase IV of the VM was uncorrelated to phase II changes, which suggests intact autonomic vasoconstriction. We conclude that the BP decrease during the VM is related to a variable decrease in thoracic blood volume that may be sufficient to preclude pressure recovery during phase II even with normal resting peripheral vasoconstriction. The VM depends on vascular as well as autonomic activation, which broadens its utility but complicates its analysis.

Adolescent↗
PubMed1995

Human pupillary light reflex during and after two-fold Valsalva maneuver.

The influence of the Valsalva maneuver on the pupillary light reflex and on the parameters of human pupillogram were studied in 9 normal volunteers (mean age 21.0 years). The consensual pupillary reactions to light were recorded using a infrared-reflecting pupillograph; pupillogram records were processed off-line by a computer system. Latency time increased during the Valsalva maneuver and normalized in the first minute after its end. No significant changes were found in constriction time. Half-redilatation time showed the opposite dynamics of latency time. The amplitude diminished during Valsalva maneuver and in the first minute after it. These results suggest a possible alteration of the autonomic nervous regulation during Valsalva maneuver and especially some changes in parasympathetic outflow to human iris sphincter. The possible effect of prevailing parasympathetic or sympathetic activity on pupillometry parameters during some phases of the Valsalva maneuver and after its end is discussed.

Adult↗
PubMed1998

Normative data on phases of the Valsalva maneuver.

The phases of the Valsalva maneuver have well-known pathophysiology, and are used in the evaluation of adrenergic function. Because scant normative data is available, we have evaluated normative data for the Valsalva maneuver in control subjects. The patient, supine, performed the Valsalva maneuver maintaining an expiratory pressure of 40 mm Hg for 15 seconds. We reviewed 188 Valsalva maneuver recordings of normal control subjects, and recordings were excluded if two reproducible recordings were not obtained, or if expiratory pressure was <30 mm Hg or < 10 seconds. One hundred and three recordings were acceptable for analysis; 47 female and 56 male subjects, age in years (mean +/- SD) was 52.2+/-17.3 and 44.8+/-17.3, respectively. The association of expiratory pressure with age (P < 0.001) and gender ( P < 0.001) was complex, expressed as a parabola in both men and women, but resulted in phases I and III that were not significantly different. An increase in age resulted in a progressively more negative phase II_E (P < 0.05) and attenuation of phase II_L (P < 0.01). An increase in supine blood pressure resulted in a significantly more negative phase II_E (P < 0.001) and a lower phase IV. Phase IV is unaffected by age and gender.

Adolescent↗
PubMed2001

[Change of cross-sectional area of the right internal jugular vein: effect of Trendelenburg position and valsalva maneuver].

To compare the effect of Valsalva maneuver and 10 degrees Trendelenburg position on the right internal jugular vein (RIJV), we measured RIJV cross-sectional area using ultrasound imaging during these procedures. The study group consisted of 13 normal healthy volunteers (6 males, 7 females, aged 25-47) with no history of neck surgery or right internal jugular vein (RIJV) puncture. All ultrasound images were obtained at the level of the cricoid cartilage. The subjects were positioned supine, and the measurements were taken with the subjects supine, under Valsalva maneuver, and under 10 degrees Trendelenburg tilt position. The cross-sectional areas of the RIJV during Valsalva maneuver and 10 degrees Trendelenburg position compared to those with supine position were 314 +/- 162%, and 192 +/- 96%, respectively. We conclude that both procedures increase cross-sectional area of IRJV significantly and in this respect Valsalva maneuver is more effective than Trendelenburg position.

Adult↗
PubMed1986

The Valsalva maneuver and response revisited.

The Valsalva maneuver is a time-honored technique that is commonly used at the bedside for the evaluation of heart murmurs. It is also a valuable adjunct in the evaluation of left ventricular function and autonomic dysfunction. In this article, we describe the normal and abnormal responses to the Valsalva maneuver and provide insight into the underlying hemodynamics in conditions that provoke an abnormal response.

Blood Pressure↗
PubMed2002

The Valsalva maneuver in Chagas disease patients without cardiopathy.

BACKGROUND: The Valsalva maneuver is a simple and reliable test of parasympathetic heart control that can also be used as a trigger of cardiac arrhythmia. Few studies are available about the Valsalva maneuver in Chagas disease patients without cardiac involvement and their results are contradictory. In a cross-sectional study, we compared Chagas disease patients without cardiac involvement and normal individuals using the Valsalva maneuver in order to study the vagal cardiac control and the occurrence of cardiac arrhythmia in the early phase of Chagas disease. METHODS: Fifty-nine patients with Chagas disease without cardiac involvement and 37 controls were submitted to a carefully standardized Valsalva maneuver. Cardiac vagal control was assessed by the Valsalva ratio and the occurrence of cardiac arrhythmia was recorded and coded. RESULTS: The two groups were comparable in terms of left ventricular ejection fraction and left ventricular end-diastolic dimension. When compared to the control group, patients with Chagas disease had significantly lower Valsalva ratios (1.81+/-0.41 versus 2.01+/-0.41, P=0.017) which were not significantly correlated with age, left ventricular function or the presence of radiological esophageal abnormalities. Atrioventricular block (mainly 2nd degree Mobitz type I) occurred exclusively in Chagas disease patients (15,6%, P=0.021) and may indicate an early involvement of the AV node. Premature ventricular contraction was more frequent in Chagas disease patients (16.9% versus 8.1%, P=0.217), although the difference was not statistically significant. CONCLUSION: The Valsalva maneuver is a useful test to detect early vagal dysfunction in Chagas disease patients without cardiac involvement.

Adult↗
PubMedDate not supplied

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure.

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.

Adult↗
PubMed2002

Brain responses associated with the Valsalva maneuver revealed by functional magnetic resonance imaging.

The Valsalva maneuver, a test frequently used to evaluate autonomic function, recruits discrete neural sites. The time courses of neural recruitment relative to accompanying cardiovascular and breathing patterns are unknown. We examined functional magnetic resonance imaging signal changes within the brain to repeated Valsalva maneuvers and correlated these changes with physiological trends. In 12 healthy subjects (age, 30-58 yr), a series of 25 volumes (20 gradient echo echo-planar image slices per volume) was collected using a 1.5-Tesla scanner during a 60-s baseline and 90-s challenge period consisting of three Valsalva maneuvers. Regions of interest were examined for signal intensity changes over baseline and challenge conditions in cardiorespiratory-related regions. In addition, whole brain correlations between signal intensity and heart rate and airway load pressure were performed on a voxel-by-voxel basis. Significant signal changes, correlated with the time course of load pressure and heart rate, emerged within multiple areas, including the amygdala and hippocampus, insular and lateral frontal cortices, dorsal pons, dorsal medulla, lentiform nucleus, and fastigial and dentate nuclei of the cerebellum. Signal intensities peaked early in the Valsalva maneuver within the hippocampus and amygdala, later within the dorsal medulla, pons and midbrain, and deep cerebellar nuclei, and last within the lentiform nuclei and the lateral prefrontal cortex. The ventral pontine signals increased during the challenge, but not in a fashion correlated to load pressure or heart rate. Sites showing little or no correlation included the vermis and medial prefrontal cortex. These data suggest an initiating component arising in rostral brain areas, a later contribution from cerebellar nuclei, basal ganglia, and lateral prefrontal cortex, and a role for the ventral pons in mediating longer term processes.

Adult↗
PubMed1998

Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.

STUDY OBJECTIVE: To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. METHODS: This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients were at least 10 years of age with regular narrow complex tachycardia and had an ECG diagnosis of SVT. Patients with regular narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic status. RESULTS: One hundred forty-eight instances of SVT were studied Sixty-two patients underwent Valsalva maneuver first with conversion in 12 (success rate of 19.4%). Eighty-six underwent CSM first with conversion in 9 (success rate 10.5%). Carotid sinus massage was used in the 50 cases of SVT in which conversion was not achieved with the Valsalva maneuver. Conversion occurred in 7 cases (success rate 14.0%). For the 77 cases of SVT in which initial CSM did not achieve conversion, conversion occurred in 13 with the Valsalva maneuver (success rate 16.9%). The Valsalva maneuver and CSM achieved conversion in a total of 41 instances of SVT (success rate 27.7%). CONCLUSION: Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM.

Adult↗
PubMed1996

Evaluation of impaired cerebral autoregulation by the Valsalva maneuver.

BACKGROUND AND PURPOSE: Transcranial Doppler sonography has recently been used to describe cerebral hemodynamics during the Valsalva maneuver in normal human subjects. Since some changes in flow velocity during the Valsalva maneuver seem to reflect the brain's autoregulatory response to a decrease in cerebral perfusion pressure during the strain, we hypothesized that this method could identify vascular territories with impaired autoregulatory capacity. METHODS: Eight patients with unilateral (n=7) or bilateral (n=1) severe obstruction of the internal carotid artery and impaired vascular responses to the CO2 reactivity test and to dynamic autoregulation testing were studied. We compared changes in flow velocities and blood pressures during defined phases of the Valsalva maneuver in the patients with the results in a group of 17 normal volunteers. We defined two indices to evaluate autoregulatory capacity based on the response to the Valsalva maneuver. RESULTS: During the Valsalva maneuver, changes in flow velocity in the middle cerebral arteries ipsilateral to the lesions showed characteristic abnormalities compared with the normal pattern. Autoregulatory indices of these vessels as defined by the Valsalva maneuver were significantly different from those with normal vascular reactivity to CO2 (P<.0001). There were good correlations between an index based on the changes in flow velocity and blood pressure in phase II and the results of the CO2 test (r=.78; P<.0001) or those of dynamic autoregulatory testing (r=.6; P<.0001). CONCLUSIONS: Vascular territories with severely impaired vasomotor reactivity due to carotid obstruction can be identified by transcranial Doppler sonography by their pattern of flow velocity changes if their autoregulatory capacity is challenged during the Valsalva maneuver.

Adult↗
PubMed1983

Radionuclide analysis of sequential changes in central circulatory volumes: inspiration, expiration, and the Valsalva maneuver.

We evaluated the effects of deep inspiration, expiration, and the Valsalva maneuver on composite cardiac (left and right ventricular) and pulmonary volumes using equilibrium radionuclide angiography in 15 adult males without left or right ventricular dysfunction. The additional effects of nitroglycerin during these maneuvers were also examined. Midexpiration was used as the control point and data analyzed as a ratio (e.g., inspiration counts divided by midexpiration counts). Left ventricular volume (LVV) declined with inspiration (0.90 +/- 0.08 inspiratory/midexpiration) and with the Valsalva maneuver (0.89 +/- 0.08 Valsalva/midexpiration). Similar changes occurred after nitroglycerin, although the effects of the Valsalva maneuver on LVV were exaggerated when compared to the initial control intervention (0.79 +/- 0.09, vs 0.88 +/- 0.07, p less than .05). Right ventricular volume (RVV) increased with inspiration and decreased with the Valsalva maneuver; these changes were similar after nitroglycerin. Pulmonary blood volume (PBV) was greater with inspiration than expiration (1.02 +/- 0.10 vs 0.95 +/- 0.05, p less than .05), and was reduced with the Valsalva maneuver. Nitroglycerin reduced significantly all volumes and the reduction was similar for each compartment when respiratory interventions were compared. We conclude that blood pool imaging can be used to characterize abrupt fluxes in central circulatory volumes. Blood pool imaging of the heart and lungs should be considered a technique for monitoring the distribution of blood volume during acute pharmacologic and physiologic alterations.

Adult↗
PubMed2005

Detection of right to left shunting through a patent foramen ovale in Japanese patients with ischemic stroke by transesophageal echocardiography using a standardized Valsalva maneuver.

We attempted to clarify the usefulness of transesophageal echocardiography performed using a standardized Valsalva maneuver to detect the presence of a patent foramen ovale in Japanese patients with ischemic stroke. Four hundred ninety six patients with ischemic stroke who were admitted to the Yokohama City Brain and Stroke Center between September 1999 and February 2002 were enrolled for the study. All the enrolled patients underwent transesophageal echocardiography with contrast injection and color Doppler imaging. During the procedure, a standardized Valsalva maneuver was performed to induce right to left shunting through a patent foramen ovale. Other related structural abnormalities, such as atrial septal aneurysm and the Chiari network anomaly, were also detected by the test. Transesophageal echocardiography without the Valsalva maneuver revealed a functional right to left communication in only 8.2% of the ischemic stroke patients, whereas the procedure conducted using a standardized Valsalva maneuver to provoke shunting revealed a patent foramen ovale in 15.3% of the patients. The presence of an atrial septal aneurysm or the Chiari network anomaly was not sensitive or specific enough to predict the presence of a patent foramen ovale as diagnosed by transesophageal echocardiography using the standardized Valsalva maneuver. Our results suggest that the standardized Valsalva maneuver is a safe and useful technique to detect the presence of a patent foramen ovale, which is potentially known to be associated with paradoxical embolism.

Aged↗
PubMedDate not supplied

The effect of Valsalva maneuver on P wave in 12-lead surface electrocardiography in patients with paroxysmal atrial fibrillation.

The previous studies relating to the effect of the Valsalva maneuver on P wave do not provide detailed information. In those studies, the parameters related to P wave duration during the release phase of the Valsalva maneuver were evaluated. The authors evaluated P wave amplitude as well as P wave duration during the strain phase of the Valsalva maneuver. Thirty-seven normal subjects and 36 patients with paroxysmal atrial fibrillation (PAF) were included in the study. Twelve-lead surface electrocardiography (ECG) was obtained from all the patients before and during the strain phase of the Valsalva maneuver. The authors evaluated the parameters related to both P wave duration and P wave amplitude. The highest P wave voltage was expressed as the P wave amplitude maximum (P amp max), the lowest P wave voltage as the P wave amplitude minimum (P amp min), and the P wave amplitude dispersion (P amp dispersion) as "the P amp max - the P amp min." Also, the maximum P wave duration was expressed as the P maximum (P max), the minimum P wave duration as the P minimum (P min), and the P wave dispersion as "the maximum P wave duration (P max) - the minimum P wave duration (P min)." All these parameters were measured before and during the strain phase of the Valsalva maneuver. P max, P dispersion, P amp max, and P amp dispersion were higher in patients with PAF compared to those of normal subjects before the Valsalva maneuver. In normal subjects, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly higher in the strain phase of the Valsalva maneuver than before (p<0.01, p<0.01, p<0.05, and p<0.05, respectively). In the patients with PAF, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly lower during the strain phase of the Valsalva maneuver than before. In conclusion, in the patients with PAF, P wave parameters were decreased during the strain phase of the Valsalva maneuver, approaching to the normal levels.

Adult↗
PubMed1999

Intraocular pressure changes: the influence of psychological stress and the Valsalva maneuver.

The effects of psychological stress and the Valsalva maneuver on short-term variations of intraocular pressure (IOP) were studied in 49 healthy adults. Psychological stress consisted of mental arithmetic tasks presented in counterbalanced order by computer and by the experimenter. Additionally, a standardized Valsalva maneuver was performed (in counterbalanced order with the psychological stressors). IOP was measured with a Goldmann tonometer before and after performance of each stressor. All three stressors transiently and highly significantly increased IOP, although the Valsalva maneuver produced changes of a greater magnitude (10.2 mmHg) than the psychological stressors (1.3 mmHg). Subjective stress ratings and heart rate increased in response to all stressors. There were no effects of task sequence, eye muscle tension, sex, smoking status (some smokers misreported their smoking status), or regular marijuana use, but regular physical exercise was associated with less IOP increase during psychological stress.

Adult↗
PubMed2004

[Doppler ultrasound diagnosis of lower extremity deep vein insufficiency: Valsalva maneuver or pneumatic cuff?].

PURPOSE: To compare the efficacy of Valsalva maneuver and pneumatic compression techniques in detecting lower extremity deep venous and saphenofemoral insufficiency. MATERIALS AND METHODS: Eighty-one extremities evaluated in 43 patients who had undergone Doppler ultrasound examination of the lower extremity venous system were included in the study. Valsalva maneuver and pneumatic cuff techniques were used to elicit reflux in the standing position. Reflux was investigated with spectral Doppler in the superficial femoral vein, popliteal vein, the proximal segment of the great saphenous vein close to its junction with the femoral vein and in its caudal segment at the medial aspect of the knee. The same measurements were repeated after rapid deflation of the pneumatic cuff, which was applied to the calf and was initially inflated to 200 mmHg. Retrograde flow exceeding 1000 msec was regarded as insufficiency. The results of the two techniques at each venous segment were compared with the McNemar test. RESULTS: Deep venous and/or saphenofemoral insufficiency were detected in 61 of the 81 extremities. The cuff deflation technique was superior at the popliteal vein and caudal segment of the great saphenous vein. The Valsalva maneuver was superior at the superficial femoral vein. The statistical results did not change when the McNemar test was repeated for reflux exceeding 2000 msec. CONCLUSION: Combined application of Valsalva maneuver and pneumatic cuff techniques will lead to more accurate evaluation and increased detection of lower extremity venous insufficiency.

Adolescent↗