Normative Data on Phases of the Valsalva Maneuver

Denq, Jong Chyou; O’Brien, Peter C.; Low, Phillip A.

doi:10.1097/00004691-199811000-00013

Cited by 53 publications

(66 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We used CASS scoring instead of percentiles for a number of reasons. Although we have a large normative database of 557 normal subjects aged 10 -85 years (14,19) and have percentiles for the majority of tests, there are a number of practical limitations. First, the distribution of results was not normal for all tests.…”

Section: Discussionmentioning

confidence: 99%

“…The number of parameters evaluated in beat-to-beat arterial waveform is large, and difficulties in quantitating these variables render the percentile approach impractical. CASS values define deficits that are corrected for age and sex (14,19). A score of 1 indicates a score that is between the 1st percentile and a loss of up to 25% of function.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Autonomic Symptoms and Diabetic Neuropathy

et al. 2004

Self Cite

View full text Add to dashboard Cite

OBJECTIVE—The prevalence of autonomic symptoms and deficits in certain systems is known, but a comprehensive autonomic symptom profile in diabetes is not available. We aimed to estimate this using a laboratory evaluation of autonomic function and a validated self-report measure of autonomic symptoms in patients and matched control subjects from the population-based Rochester Diabetic Neuropathy Study. RESEARCH DESIGN AND METHODS—Participants included 231 patients with diabetes (type 1, n = 83; type 2, n = 148) and 245 healthy age-matched control subjects. We assessed symptoms using a validated self-report instrument (Autonomic Symptom Profile) and evaluated the severity and distribution of autonomic deficits (cardiovagal, sudomotor, adrenergic) with the objective, laboratory-based Composite Autonomic Severity Score (CASS). RESULTS—Autonomic symptoms were present more commonly in type 1 than in type 2 diabetes, with symptoms of orthostatic intolerance, secretomotor, urinary control, diarrhea, and sleep disturbance and pupillomotor, vasomotor, and erectile dysfunction significantly increased over healthy control subjects in type 2 diabetic patients. The prevalence of autonomic impairment was 54% in type 1 and 73% in type 2 diabetic patients. Severity of autonomic failure was mild overall (mean CASS 2.3; maximum 10), with orthostatic hypotension occurring in 8.4 and 7.4% of type 1 and 2 diabetic patients, respectively. Fourteen percent of patients had a CASS ≥5, indicating moderate to severe generalized autonomic failure. The correlation of symptoms with autonomic deficits (CASS) was better in type 1 than type 2 diabetic subjects and was weak overall. CONCLUSIONS—These findings indicate that autonomic symptoms and deficits are common in diabetes, but mild in severity, and that the correlation between symptom scores and deficits is overall weak in mild diabetic neuropathy, emphasizing the need to separately evaluate autonomic symptoms.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Autonomic Symptoms and Diabetic Neuropathy

et al. 2004

Self Cite

View full text Add to dashboard Cite

show abstract

“…Subjects were asked to blow against a closed airway (i.e., into a plastic bugle) at an expiratory pressure of 40 mmHg for 15 s. If a subject was unable to generate 40 mmHg of expiratory pressure, the subject was asked to perform the maneuver at the highest pressure that could comfortably be generated. This sustained increase in intrathoracic pressure followed by its abrupt release causes a characteristic four-phase response in arterial pressure (5,23,33). Phase II consists of two parts; in early phase II (PhII E), arterial pressure decreases due to decreased venous return, and in late phase II, pressure begins to increase due to the appropriate HR and MSNA responses elicited by PhII E. The sympathoexcitatory response to PhIIE of the Valsalva maneuver provides a measure of sympathetic baroreflex function.…”

Section: Protocolmentioning

confidence: 99%

Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome

Swift

Charkoudian

Dotson³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

-Postural orthostatic tachycardia syndrome (POTS) is characterized by excessive tachycardia during orthostasis. To test the hypothesis that patients with POTS have decreased sympathetic neural responses to baroreflex stimuli, we measured heart rate (HR) and muscle sympathetic nerve activity (MSNA) responses to three baroreflex stimuli including vasoactive drug boluses (modified Oxford technique), Valsalva maneuver, and head-up tilt (HUT) in POTS patients and healthy control subjects. The MSNA response to the Valsalva maneuver was significantly greater in the POTS group (controls, 26 Ϯ 7 vs. POTS, 48 Ϯ 6% of baseline MSNA/mmHg; P ϭ 0.03). POTS patients also had an exaggerated MSNA response to 30°HUT (controls, 123 Ϯ 24 vs. POTS, 208 Ϯ 30% of baseline MSNA; P ϭ 0.03) and tended to have an exaggerated response to 45°HUT (controls, 137 Ϯ 27 vs. POTS, 248 Ϯ 58% of baseline MSNA; P ϭ 0.10). Sympathetic baroreflex sensitivity calculated during administration of the vasoactive drug boluses also tended to be greater in the POTS patients; however, this did not reach statistical significance (P ϭ 0.15). Baseline MSNA values during supine rest were not different between the groups (controls, 23 Ϯ 4 vs. POTS, 16 Ϯ 5 bursts/100 heartbeats; P ϭ 0.30); however, resting HR was significantly higher in the POTS group (controls, 58 Ϯ 3 vs. POTS, 82 Ϯ 4 beats/min; P ϭ 0.0001). Our results suggest that POTS patients have exaggerated MSNA responses to baroreflex challenges compared with healthy control subjects, although resting supine MSNA values did not differ between the groups. intolerance; blood pressure; heart rate; Valsalva maneuver; head-up tilt POSTURAL ORTHOSTATIC TACHYCARDIA syndrome (POTS) is a chronic, potentially debilitating condition that often occurs in otherwise healthy individuals who are most often young women. Patients with this condition (also known as idiopathic orthostatic intolerance) exhibit excessive tachycardia [increase in heart rate (HR) of Ͼ30 beats/min] during head-up tilt (HUT) in the absence of significant orthostatic hypotension. They also develop dizziness, fatigue, headache, and/or anxiety with standing or HUT (24,34). Although POTS has become better recognized clinically in recent years, the mechanisms underlying the pathophysiology of this condition remain unclear.In humans, normal baroreflex physiology involves increased HR, increased vascular sympathetic nerve activity, and peripheral vasoconstriction in response to decreased venous return during upright posture (31). These normal responses result in maintenance of arterial pressure with the upright posture and an absence of symptoms such as those reported by POTS patients. It is not clear whether the excessive tachycardia with orthostasis in POTS patients is the cause or the consequence of one or more abnormal steps in the baroreflex pathway. For example, evidence is conflicting regarding baroreflex control of HR in patients with orthostatic intolerance. Some researchers have reported decreased sensitivity of baroreflex control of HR in these ...

show abstract

“…The calculated difference between baseline MAP and the top of phase IV (PIV) represents the PIV measurement and reflects beta-adrenergic activity. 35 The PV was calculated using the Evans Blue Dye method, as previously described. 36 An 18-gauge intravenous saline lock was placed in the antecubital vein for baseline blood draw and administration of Evans blue dye and subsequent blood draws.…”

Section: Hemodynamic Assessmentmentioning

confidence: 99%

The Relationship of a Family History for Hypertension, Myocardial Infarction, or Stroke With Cardiovascular Physiology in Young Women

et al. 2014

View full text Add to dashboard Cite

Cardiovascular disease (CVD) and preeclampsia share several pathophysiologic risk factors. We examined family history (FH) and physiologic status in 60 healthy, nulliparous women to determine the relationship between FH and known risk factors for CVD. Data are presented as mean + standard error (SE). Decreased uterine blood flow was observed in women with FH of hypertension (þFH: 21.5 + 1.7, no FH: 33.3 + 9.0 mL/min; P ¼ .04). Women reporting an FH of stroke showed increased alpha-and beta-adrenergic response, as measured by Valsalva maneuver (a: FH: 24.7 + 1.9, ÀFH: 18.9 + 1.1 mm Hg, P ¼ .02; b: FH: 22.0 + 2.1, ÀFH: 16.9 + 1.4 mm Hg; P ¼ .04), and increased cardiac output (4.83 + 0.22 vs 4.31 + 0.12 L/min; P ¼ .01). We identified no significant physiologic associations linked to an FH of myocardial infarction. Our observations show significant differences in physiologic characteristics in women with specific CVD family histories. These data, coupled with known heritable contributions to CVD and preeclampsia, suggest a distinct physiologic phenotype that may link preeclampsia risk with FH of CVD, independent of pregnancy.

show abstract

Normative Data on Phases of the Valsalva Maneuver

Cited by 53 publications

References 21 publications

Autonomic Symptoms and Diabetic Neuropathy

Autonomic Symptoms and Diabetic Neuropathy

Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome

The Relationship of a Family History for Hypertension, Myocardial Infarction, or Stroke With Cardiovascular Physiology in Young Women

Contact Info

Product

Resources

About