The Valsalva manoeuvre: physiology and clinical examples

Area of Science:

• Cardiology
• Autonomic Neurology
• Physiology

Background:

• The Valsalva manoeuvre (VM) involves forced expiration against a closed airway, inducing complex cardiovascular changes.
• It engages multiple regulatory mechanisms, primarily baroreceptor reflexes, to control arterial blood pressure (BP).
• Pulmonary stretch receptors and chemoreceptors also contribute to the response, acting synergistically or antagonistically.

Purpose of the Study:

• To provide a comprehensive analysis of the Valsalva manoeuvre's physiology and pathophysiology.
• To review the wide-ranging applications of the VM in diagnosing cardiovascular and autonomic nervous system conditions.
• To illustrate normal and abnormal hemodynamic responses to the VM with clinical examples.

Main Methods:

• Literature review analyzing the physiological effects of the Valsalva manoeuvre.
• Examination of cardiovascular and heart rate changes during and after the VM.
• Correlation of abnormal responses with patient conditions and technical execution factors.

Main Results:

• The VM elicits a complex cardiovascular response influenced by intrathoracic and intra-abdominal pressure changes.
• Abnormal responses to the VM are indicative of various underlying medical conditions and dysfunctions.
• Factors such as patient's cardiovascular system, autonomic function, and VM execution technique affect the response.

Conclusions:

• The Valsalva manoeuvre is a valuable diagnostic tool for assessing autonomic function and cardiovascular health.
• Analysis of BP and heart rate dynamics during the VM can confirm or diagnose several dysfunctions.
• Understanding the interplay between physiological responses and technical execution is crucial for accurate interpretation of the VM.