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Valsalva Maneuver
Aka: Valsalva Maneuver, Valsalva's Maneuver, Modified Valsalva Maneuver
- Technique
- Forceful expiration against a closed mouth and nose
- Physiology
- Increases intrathoracic pressure
- Briefly (<3-5 seconds) results in mildly increased Cardiac Output
- Decreases venous return
- After first 3-5 seconds, results in fall in Cardiac Output, and typically drop in Blood Pressure
- Indications
- Pressure equalization of nose and sinuses
- Examples: Drop in altitude in plane flight or increased external pressure in diving
- Other maneuvers are preferred (yawning, Swallowing)
- Evaluate Tympanic Membrane mobility
- Supraventricular Tachycardia
- Functions as a Vagal Maneuver
- Postural modification significantly increases efficacy in PSVT cardioversion
- Valsalva is initially performed with head of bed at 30-45 degrees
- In study, Patient blew into a manometer attempting to sustain 40 mmHg for 15 seconds
- Patient repositioned immediately after Valsalva Maneuver
- Patient is layed supine and legs are passively raised
- References
- Appelboam (2015) Lancet 384(10005):1747-53 +PMID:26314489 [PubMed]
- http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61485-4/abstract
- Evaluate cardiac murmur
- Increases murmur or abnormal heart sounds
- Hypertrophic Cardiomyopathy
- Mitral Valve Prolapse
- Decreases murmur
- Atrial Septal Defect
- Aortic Stenosis
- References
- Bates (1991) Physical Exam, 5th ed, Lippencott, p. 302