Srivastav Shival, Jamil Radia T., Dua Anterpreet, Zeltser Roman
All India Institute of Medical Sciences
Allama Iqbal Medical College
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.
瓦尔萨尔瓦动作包括在声门关闭的情况下用力呼气，会产生显著的血流动力学变化，这些变化可分为4个阶段。人们在许多日常活动中经常会进行瓦尔萨尔瓦动作，包括排便时用力、举重物或吹奏萨克斯管。现在，瓦尔萨尔瓦动作被用于评估自主神经功能、评估心力衰竭、终止室上性心动过速以及鉴别心脏杂音。像改良瓦尔萨尔瓦动作（用于室上性心动过速）和反向瓦尔萨尔瓦动作（用于增加迷走神经张力）等变体扩展了其临床应用。该操作还用于诊断（如心脏杂音、精索静脉曲张、肝血管瘤）、外科手术（如神经外科手术和胸主动脉腔内修复术）以及分娩管理。虽然瓦尔萨尔瓦动作一般是安全的，但对于患有冠状动脉疾病或视网膜病变等疾病的患者应谨慎使用，因为它偶尔会诱发晕厥、心律失常或瓦尔萨尔瓦视网膜病变。最佳测试条件包括在40毫米汞柱下进行瓦尔萨尔瓦动作15秒，并根据具体情况调整患者体位（如仰卧、坐姿或卧位）。瓦尔萨尔瓦动作于1704年由意大利医生安东尼奥·玛丽亚·瓦尔萨尔瓦在他的著作中首次描述。安东尼奥·瓦尔萨尔瓦最初描述使用这个动作通过穿孔有效地从中耳腔排出脓性液体以及从耳朵排出异物。1850年，爱德华·弗里德里希和恩斯特·海因里希·韦伯报告了瓦尔萨尔瓦动作导致的昏厥。韦伯在对自己进行瓦尔萨尔瓦动作时，经历了心动过缓和意识丧失。后来，在1950年，爱德华·彼得·沙佩伊 - 谢弗描述了瓦尔萨尔瓦动作的心血管效应，包括胸内压升高、心脏充盈压降低和心搏量减少。他对连续血压的研究表明，当胸内压升高时血压会下降，随后舒张压会升高。沙佩伊 - 谢弗将这种现象描述为压力感受器对脉压降低的反应。从那时起，这个动作已在多个临床领域中使用，从评估自主神经功能障碍到治疗心律失常，以及作为心力衰竭的一个指标。
