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ARTICLE |

VALSALVA MANEUVER AS A DIAGNOSTIC AID FREE

C. Warren Irvin, Jr., M.D.
[+] Author Affiliations

Columbia, S. C.


JAMA. 1959;170(7):787-791. doi:10.1001/jama.1959.03010070027007
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The test for cardiac function here described consists of having the patient blow into a manometric system in such a way as to maintain an intrapulmonic pressure of 40 mm. Hg for 10 seconds. During and immediately after this straining period the patient's blood pressure is noted. A four-phase response, consisting of a brief rise of 30 to 50 mm. Hg in systolic blood pressure, a gradual fall to resting level, a brief fall below resting level when the strain is released, and a secondary rise of 15 to 40 mm., is considered a normal response. The test was applied to 205 selected office patients. Positive results (abnormal responses) were obtained in 35. Of these, 14 showed clinical signs of congestive heart failure and 11 had significant heart disease.

REFERENCES

Gorlin, R.; Knowles, J. H.; and Storey, C. F.:  Valsalva Maneuver as Test of Cardiac Function: Pathologic Physiology and Clinical Significance , Am. J. Med. 22:197-212 ( (Feb.) ) 1957;.
Knowles, J. H.; Gorlin, R.; and Storey, C. F.:  Clinical Test for Pulmonary Congestion with Use of Valsalva Maneuver , J. A. M. A. 160:44-48 ( (Jan. 7) ) 1956;.
Ard, R. W., and Twining, R. H.:  Evaluation of Valsalva Test in Bedside Diagnosis of Dyspnea , Am. J. M. Sc. 234: 403-412 ( (Oct.) ) 1957;.
Sharpey-Schafer, E. P.: (d)  Effects of Valsalva's Manoeuvre on Normal and Failing Circulation , Brit. M. J. 1:693-695 ( (March 19) ) 1955;
 Peripheral Circulation in Circulatory Failure , Brit. M. Bull. 8:331-332, 1952;.
Elisberg, E.; Singian, E.; Miller, G.; and Katz, L. N.:  Effect of Valsalva Maneuver on Circulation: III. Influence of Heart Disease on Expected Poststraining Overshoot , Circulation 7:880-889 ( (June) ) 1953;.
McIntosh, H. D.; Burnum, J. F.; Hickam, J. B.; and Warren, J. V.:  Circulatory Changes Produced by Valsalva Maneuver in Normal Subjects, Patients with Mitral Stenosis, and Autonomic Nervous System Alterations , Circulation 9:511-520 ( (April) ) 1954;.
Judson, W. E.; Hatcher, J. D.; and Wilkins, R. W.:  Blood Pressure Responses to Valsalva Maneuver in Cardiac Patients With and Without Congestive Heart Failure , Circulation 11:889-899 ( (June) ) 1955;.
Mills, H., and Kattus, A. A., Jr.:  Emphysema Response to Forced Straining (Valsalva's Maneuver) , Circulation 17:65-71 ( (Jan.) ) 1958;.
Goldberg, H.; Elisberg, E. I.; and Katz, L. N.:  Effects of Valsalva-like Maneuver upon Circulation in Normal Individuals and Patients with Mitral Stenosis , Circulation 5:38-47 ( (Jan.) ) 1952;.
Greene, D. G., and Bunnell, I. L.:  Circulatory Response to Valsalva Maneuver of Patients with Mitral Stenosis With and Without Autonomic Blockade , Circulation 9:264-268 ( (Aug.) ) 1953;.
Burroughs, R. W., and Bruce, R. A.:  Significance of Abnormal Phase II Response to Valsalva Maneuver in Cardiac Patients , Circulation 14:72-76 ( (July) ) 1956;.
Hamilton, W. F.; Woodbury, R. A.; and Harper, H. T., Jr.:  Arterial Cerebrospinal and Venous Pressures in Man During Cough and Strain , Am. J. Physiol. 141:42-50 ( (March) ) 1944;.
References 1d and e.
Sarnoff, S. J.; Hardenbergh, E.; and Whittenberger, J. L.:  Mechanism of Arterial Pressure Response to Valsalva Test: Basis for Its Use as Indicator of Intactness of Sympathetic Outflow , Am. J. Physiol. 154:316-327 ( (Aug.) ) 1948;.
Price, H. L., and Conner, E. H.:  Certain Aspects of Hemodynamic Response to Valsalva Maneuver , J. Appl. Physiol. 5:449-456 ( (Feb.) ) 1953;.
Stucki, P.; Hatcher, J. D.; Judson, W. E.; and Wilkins, R. W.:  Studies of Circulation Time During Valsalva Test in Normal Subjects and in Patients with Congestive Heart Failure , Circulation 11:900-908 ( (June) ) 1955;.

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Gorlin, R.; Knowles, J. H.; and Storey, C. F.:  Valsalva Maneuver as Test of Cardiac Function: Pathologic Physiology and Clinical Significance , Am. J. Med. 22:197-212 ( (Feb.) ) 1957;.
Knowles, J. H.; Gorlin, R.; and Storey, C. F.:  Clinical Test for Pulmonary Congestion with Use of Valsalva Maneuver , J. A. M. A. 160:44-48 ( (Jan. 7) ) 1956;.
Ard, R. W., and Twining, R. H.:  Evaluation of Valsalva Test in Bedside Diagnosis of Dyspnea , Am. J. M. Sc. 234: 403-412 ( (Oct.) ) 1957;.
Sharpey-Schafer, E. P.: (d)  Effects of Valsalva's Manoeuvre on Normal and Failing Circulation , Brit. M. J. 1:693-695 ( (March 19) ) 1955;
 Peripheral Circulation in Circulatory Failure , Brit. M. Bull. 8:331-332, 1952;.
Elisberg, E.; Singian, E.; Miller, G.; and Katz, L. N.:  Effect of Valsalva Maneuver on Circulation: III. Influence of Heart Disease on Expected Poststraining Overshoot , Circulation 7:880-889 ( (June) ) 1953;.
McIntosh, H. D.; Burnum, J. F.; Hickam, J. B.; and Warren, J. V.:  Circulatory Changes Produced by Valsalva Maneuver in Normal Subjects, Patients with Mitral Stenosis, and Autonomic Nervous System Alterations , Circulation 9:511-520 ( (April) ) 1954;.
Judson, W. E.; Hatcher, J. D.; and Wilkins, R. W.:  Blood Pressure Responses to Valsalva Maneuver in Cardiac Patients With and Without Congestive Heart Failure , Circulation 11:889-899 ( (June) ) 1955;.
Mills, H., and Kattus, A. A., Jr.:  Emphysema Response to Forced Straining (Valsalva's Maneuver) , Circulation 17:65-71 ( (Jan.) ) 1958;.
Goldberg, H.; Elisberg, E. I.; and Katz, L. N.:  Effects of Valsalva-like Maneuver upon Circulation in Normal Individuals and Patients with Mitral Stenosis , Circulation 5:38-47 ( (Jan.) ) 1952;.
Greene, D. G., and Bunnell, I. L.:  Circulatory Response to Valsalva Maneuver of Patients with Mitral Stenosis With and Without Autonomic Blockade , Circulation 9:264-268 ( (Aug.) ) 1953;.
Burroughs, R. W., and Bruce, R. A.:  Significance of Abnormal Phase II Response to Valsalva Maneuver in Cardiac Patients , Circulation 14:72-76 ( (July) ) 1956;.
Hamilton, W. F.; Woodbury, R. A.; and Harper, H. T., Jr.:  Arterial Cerebrospinal and Venous Pressures in Man During Cough and Strain , Am. J. Physiol. 141:42-50 ( (March) ) 1944;.
References 1d and e.
Sarnoff, S. J.; Hardenbergh, E.; and Whittenberger, J. L.:  Mechanism of Arterial Pressure Response to Valsalva Test: Basis for Its Use as Indicator of Intactness of Sympathetic Outflow , Am. J. Physiol. 154:316-327 ( (Aug.) ) 1948;.
Price, H. L., and Conner, E. H.:  Certain Aspects of Hemodynamic Response to Valsalva Maneuver , J. Appl. Physiol. 5:449-456 ( (Feb.) ) 1953;.
Stucki, P.; Hatcher, J. D.; Judson, W. E.; and Wilkins, R. W.:  Studies of Circulation Time During Valsalva Test in Normal Subjects and in Patients with Congestive Heart Failure , Circulation 11:900-908 ( (June) ) 1955;.
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