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ARTICLE |

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

Edward I. Elisberg, MD
JAMA. 1963;186(3):200-205. doi:10.1001/jama.1963.03710030040006.
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The blood pressure and heart rate responses to the Valsalva maneuver as measured during cardiac catheterization are a reliable index of cardiovascular integrity. The present study indicates that heart rate itself, as monitored by the electrocardiograph, is an equally reliable index of the dynamic changes occurring during and after straining. In a normal group of subjects the heart rate slowed with the onset of straining (phase 1), increased during (phase 2) and after straining (phase 3), and was followed by a marked bradycardia (phase 4). These responses occurred to a significantly lesser degree in subjects with advanced cardiac disease, the absense of the bradycardia in phase 4 being of the greatest statistical importance. Using these criteria, subjects with cardiovascular abnormalities of uncertain dynamic significance were separated into clinically valid groups of reactors and nonreactors.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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