Heart Rate Response to the Valsalva Maneuver as a Test of Circulatory Integrity

Elisberg, Edward I.

doi:10.1001/jama.1963.03710030040006

Cited by 73 publications

(38 citation statements)

References 9 publications

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“…The HF patients were consistently able to reach and maintain 30-mm Hg expiratory pressures, and these pressures are well within the 25-to 40-mm Hg levels and times (10 to 30 seconds) necessary to induce ANS activation and appropriate hemodynamic patterns. 8 The abnormal heart rate responses suggest impaired ANS processes in the HF patients, an interpretation supported by numerous other studies. 17,18 fMRI signals from several HF patient brain regions within HF subjects to the Valsalva maneuver differed significantly from controls.…”

Section: Discussionsupporting

confidence: 55%

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

Woo

Macey

Keens

et al. 2007

Congestive Heart Failure

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Heart failure (HF) is associated with aberrant autonomic nervous system (ANS) activity, with altered responses to blood pressure and breathing challenges that appear to reflect abnormal central nervous system function. The authors used functional magnetic resonance imaging (fMRI) to determine whether the Valsalva maneuver, an ANS challenge, would show abnormal responses in ANS regulatory areas of the brain in HF. Brain fMRI signal changes in 5 HF patients (left ventricular ejection fraction, 0.15±0.08; age, 50±10 years) and 14 controls (age, 47±11 years) were assessed during 3 successive Valsalva maneuvers. The hypothalamus, hippocampus, putamen, amygdala, mid‐cingulate, right insula, and cerebellar cortex showed exaggerated and phase‐shifted fMRI responses in HF; other areas showed inverted signals from those found in controls. Central ANS control areas have altered phase, extent, and direction of responses to Valsalva maneuvers in a small sample of HF patients. These findings suggest that therapeutics that address neuroprotective aspects may be useful interventions for the condition.

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Section: Discussionsupporting

confidence: 55%

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

Woo

Macey

Keens

et al. 2007

Congestive Heart Failure

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“…Despite its use in many clinical and experimental situations, only limited studies of its reproducibility have been carried out (Levin, 1966). Changes in intra-arterial blood pressure have been used to assess the response to the Valsalva manoeuvre, but heart rate changes have also been shown to be reliable (Elisberg, 1963) and have the advantage of being noninvasive.…”

mentioning

confidence: 99%

Heart rate response to Valsalva manoeuvre. Reproducibility in normals, and relation to variation in resting heart rate in diabetics.

Baldwa¹,

Ewing²

1977

Heart

109

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The reproducibility of the heart rate response to the Valsalva manoeuvre was assessed in 12 young normal subjects who each repeated the manoeuvre 10 times. The length of the RR intervals before, during, and after each Valsalva manoeuvre was measuredfrom an electrocardiogram and the changes expressed as two ratios: the 'tachycardia' ratio and the 'Valsalva' ratio. The within-subject variation was 0 044 for the tachycardia ratio and + 0<18for the Valsalva ratio, while the between-subject variation was 0 10for the tachycardia ratio and 0-37for the Valsalva ratio. The heart rate response to the Valsalva manoeuvre was alsofound to be reproducible in 7 older normal subjects.In 100 diabetic subjects with varying degrees of autonomic neuropathy, the heart rate response to the Valsalva manoeuvre was compared with the heart rate variation from a resting electrocardiogram. The heart rate variation correlated significantly with both the tachycardia ratio (r=0 727, P<0-001) and the Valsalva ratio (r=0.659, P<0 001).Thus, the heart rate response to the Valsalva manoeuvre is reproducible in normal subjects, and in diabetics, heart rate variation can simply be used as a test of autonomic function when more sophisticated tests are not available.

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“…2 Later it was German Physiologist Edward Weber who detailed cardiovascular alteration associated with the manoeuvre allowing its use for diagnostic or investigative objectives. 12,13 Hence the Valsalva manoeuvre is either therapeutic or diagnostic elucidation or to demonstrate functional mechanisms as in heart clinical examinations and investigations of cardiac autonomic function. Alternatively with the aim of simplification, correction and justice it would be preferable to call the procedure more appropriately as Valsalva-Weber manoeuvre (VWM).…”

Section: Valsalva Manoeuvrementioning

confidence: 99%

“…This is associated with transient cardiovascular changes, autonomic activity modifications, and Intrathoracic, intrabdominal and intraocular pressure increase. 12,10,14,15,16 The VWM is a measure of the HR response to BP changes resulting from the mechanical and cardiovascular effects of the VWM. By increasing Intrathoracic and intrabdominal pressure, the straining results in decrease in the venous return of blood to the heart with an increase in venous pressure, progressive arterial pressure reduction, this results in a progressive compensatory baroreflex-mediated heart rate increase.…”

Section: Valsalva Manoeuvrementioning

confidence: 99%

“…Following cessation of the straining phase, these functional changes are abruptly reversed, resulting in an overshoot of arterial pressure that is accompanied by a rapid progressive baroreflex bradycardia lasting some seconds until the return of blood pressure and heart rate to basal levels. 2,12,9,15,16,17 VWM consists of four phases, designated I to IV, which delineate the cardiovascular changes during the VWM. Phase I consists of a transient rise in BP with a variable bradycardia that results from the increased Intrathoracic and intrabdominal pressures.…”

Section: Valsalva Manoeuvrementioning

confidence: 99%

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