II. Technique

  1. Forceful expiration against a closed mouth and nose

III. Physiology

  1. Increases intrathoracic pressure
    1. Briefly (<3-5 seconds) results in mildly increased Cardiac Output
  2. Decreases venous return
    1. After first 3-5 seconds, results in fall in Cardiac Output, and typically drop in Blood Pressure

IV. Indications

  1. Pressure equalization of nose and sinuses
    1. Examples: Drop in altitude in plane flight or increased external pressure in diving
    2. Other maneuvers are preferred (Yawning, Swallowing)
  2. Evaluate Tympanic Membrane mobility
  3. Supraventricular Tachycardia
    1. Functions as a Vagal Maneuver
    2. Postural modification significantly increases efficacy in PSVT cardioversion
      1. Valsalva is initially performed with head of bed at 30-45 degrees
        1. In study, Patient blew into a manometer attempting to sustain 40 mmHg for 15 seconds
      2. Patient repositioned immediately after Valsalva Maneuver
      3. Patient is layed supine and legs are passively raised
    3. References
      1. Appelboam (2015) Lancet 384(10005):1747-53 +PMID:26314489 [PubMed]
      2. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61485-4/abstract
  4. Evaluate cardiac murmur
    1. Increases murmur or abnormal heart sounds
      1. Hypertrophic Cardiomyopathy
      2. Mitral Valve Prolapse
    2. Decreases murmur
      1. Atrial Septal Defect
      2. Aortic Stenosis

V. References

  1. Bates (1991) Physical Exam, 5th ed, Lippencott, p. 302

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Related Studies

Ontology: Valsalva Maneuver (C0042293)

Definition (MSHCZE) Usilovný výdech při zavřené hlasové štěrbině. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Forced expiratory effort against a closed GLOTTIS.
Concepts Diagnostic Procedure (T060)
MSH D014636
SnomedCT 261039008, 79837007
English Maneuver, Valsalva's, Valsalva's maneuver, Valsalva maneuver (treatment), valsalva maneuver, valsalva manoeuvre, maneuver valsalva, manoeuvre valsalva, valsalva's maneuver, maneuvre valsalva, valsalva maneuvers, Valsalva Maneuver, Valsalva's Maneuver, Maneuver, Valsalva, Maneuvers, Valsalva, Valsalva Maneuvers, Valsalva maneuver, Valsalva manoeuvre, Valsalva maneuver (qualifier value), Valsalva maneuvre
Swedish Valsalvas manöver
Czech Valsalvův manévr, Valsavův manévr
Finnish Valsalvan koe
Japanese Valsalva操作, バルサルバホウ, バルサルバ法, Valsalvaテスト, バルサルバテスト, バルサルバ操作, バルサルバ試験, ワルサルワ操作, ヴァルサルヴァテスト, ヴァルサルヴァ操作, ヴァルサルヴァ試験
German Valsalva-Maneuver, Valsalva-Versuch
Dutch valsalva-manoeuvre, Valsalva-manoeuvre, Manoevre, Valsalva-
Polish Próba Valsalvy
Hungarian Valsalva műveletsor
Norwegian Valsalvas prøve, Valsalvas manøver
French Manoeuvre de Valsalva, Manoeuvre de Vasalva
Spanish maniobra de Valsalva (calificador), maniobra de Valsalva, Maniobra de Valsalva
Italian Manovra di Valsalva
Portuguese Manobra de Valsalva