Pepine C J, Wiener L
Circulation. 1979 Jun;59(6):1304-11. doi: 10.1161/01.cir.59.6.1304.
The influence of the Valsalva maneuver (VM) on myocardial ischemia was evaluated in 24 patients with coronary heart disease. Clinical and hemodynamic responses to the VM were studied during acute ischemia manifested by angina pectoris with transient left ventricular (LV) dysfunction and compared with responses during nonischemic intervals. In the absence of evidence for acute ischemia (angina and increased LV end-diastolic pressure), six patients had abnormal hemodynamic responses to the VM. Five had lack of systolic pressure overshoot and in one, systolic pressure did not decline during straining. When the VM was performed during an ischemic episode, 14 patients had abnormal responses (12 with lack of overshoot in phase IV and two with lack of systolic pressure decline in phase II). In 18 patients a prompt decline in LV end-diastolic pressure occurred with the disappearance of angina during the VM. These changes uniformly occurred during the latter part of straining (VM phase II) as cardiac size and systolic pressure declined. No adverse effects occurred when a VM was performed during acute ischemia. Our observations suggest that the VM abruptly reduces determinants of cardiac oxygen demand, relieving acute ischemia without harmful effects.
在24例冠心病患者中评估了瓦尔萨尔瓦动作（Valsalva maneuver，VM）对心肌缺血的影响。研究了在伴有短暂左心室（LV）功能障碍的心绞痛所表现的急性缺血期间，患者对VM的临床和血流动力学反应，并与非缺血间期的反应进行比较。在无急性缺血证据（心绞痛和LV舒张末期压力升高）的情况下，6例患者对VM有异常血流动力学反应。5例患者收缩压无过冲，1例患者在用力时收缩压未下降。当在缺血发作期间进行VM时，14例患者有异常反应（12例在IV期无过冲，2例在II期收缩压无下降）。18例患者在VM期间LV舒张末期压力迅速下降，心绞痛消失。这些变化均在用力后期（VM II期）随着心脏大小和收缩压下降而出现。在急性缺血期间进行VM时未出现不良反应。我们的观察结果表明，VM可突然降低心脏氧需求的决定因素，缓解急性缺血且无有害影响。
