Valsalva Maneuver

The Valsalva maneuver involves forceful exhalation against a closed glottis, producing significant hemodynamic changes that are divided into 4 phases. Individuals frequently perform the Valsalva maneuver during many daily activities, including straining during defecation, lifting heavy weights, or playing the saxophone. The Valsalva maneuver is now utilized to assess autonomic function, evaluate heart failure, terminate supraventricular tachycardia, and differentiate cardiac murmurs. Variants like the modified Valsalva maneuver (used for supraventricular tachycardia) and reverse Valsalva maneuver (to increase vagal tone) extend its clinical applications. The procedure is also used in diagnostics (eg, heart murmurs, varicocele, liver hemangiomas), surgical procedures (eg, neurosurgery and TEVAR), and labor management. Though generally safe, the Valsalva maneuver should be used cautiously in patients with conditions like oronary artery disease or retinopathy, as it can occasionally induce syncope, arrhythmias, or Valsalva retinopathy. Optimal testing conditions include performing VM at 40 mm Hg for 15 seconds, with patient positioning (eg, supine, sitting, or recumbent) adjusted based on context. Valsalva maneuver was first described in 1704 by Antonio Maria Valsalva, an Italian physician, in his work  Antonio Valsalva originally described using this maneuver to effectively drain purulent fluids from the middle ear cavities through perforations and expulsion of foreign bodies from the ear. In 1850, Eduard Friedrich and Ernst Heinrich Weber reported a Valsalva-induced blackout. While performing a Valsalva maneuver on himself, Weber experienced bradycardia and loss of consciousness. Later, in 1950, Edward Peter Sharpey-Schafer described the cardiovascular effects of the Valsalva maneuver, including a rise in intrathoracic pressure, a decrease in heart-filling pressures, and a decreased stroke volume. His studies of continuous blood pressure showed a drop in blood pressure when the intrathoracic pressure was raised, which was followed by a rise in the diastolic pressure. Sharpey-Schafer described this phenomenon as a baroreceptor response to decreased pulse pressure. Since then, this maneuver has been used in multiple clinical domains, from evaluating autonomic dysfunction to treating arrhythmias and as a marker for heart failure.