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.