Relationship between the changes in heart rate and cardiac output during the Valsalva maneuver.

Ten young (average age 20 years) healthy male volunteers performed the Valsalva maneuver (40 mmHg for 15 seconds) in the supine and the upright position. The heart rate (HR), stroke volume (SV) and the cardiac index (CI) were registered using ECG and impedance cardiography. During the expiratory strain of the Valsalva maneuver the HR increased about equally in the two positions while the decreases in the SV and the CI were in the supine position significantly greater than in the upright position. The CI decreased to equal levels in both positions after 15 seconds of strain. The rise in the HR due to the expiratory strain did not correlate significantly with the decrease in the CI in either position. The correlation between the HR rise and the SV decrease was almost significant (p less than 0.05) in the supine position and significant (p less than 0.01) in the upright position after 5 seconds of strain but not after 10 or 15 seconds. These observations suggest that the relationship between the rise in the HR and the decrease in the venous return does not remain constant during 15 seconds of expiratory strain. Perhaps the cardiopulmonary baroreceptor reflexes affect the HR after five seconds of strain more than they do after 10 or 15 seconds of strain.