Valsalva maneuver is a forceful attempt to exhale against the airway which is closed, done by closing the mouth and the nostrils. It is used to test the cardiac function and to test the control of the autonomic system over the heart. It is used to clear the ears and nostrils in case of occupations like diving or aviation.
Valsalva maneuver is a term coined after physician Antonio Maria Valsalva. The Eustachian tube which connects the pharynx with the ear was described by him. He also invented maneuver to test the openness of the Eustachian tube. He also discovered the expulsion of pus from the middle ear.
It is used in patients with cardiac complications in association with echocardiography. Comparing the changes in the diseased heart with the normal heart gives us the type and location of the heart damage. Blood pressure response to Valsalva maneuver can give us a clue about mortality in older patients suffering from congestive heart failure. It helps us to know how longer the patient will survive. It is also useful in correcting the rapid heartbeats arising from the atria. Patients with mild coronary disease if suffer pain, it can be used to reduce the pain. The procedure of Valsalva maneuver is taught to patients having multiple sclerosis to help them evacuate the bladder completely. It is also used in patients suffering from premature ejaculation.
It is used in clinical diagnosis of problems or injuries in the nerves of cervical spine. It increases the intraspinal pressure. Hence due to this the neuropathies can be amplified and thus indicate some compression on a nerve by intervertebral disc. It is also used by dentist removal of maxillary molar tooth. It is performed to determine if perforation or antral communication exists.
When rapid pressure increases during diving or air craft, this pressure keeps the Eustachian tube closed and prevents the equalizing of the pressure across the ear drum and can lead to painful complication. This is prevented by divers by swallowing and opening the Eustachian tubes and allows the pressure to equalize and prevents the damage. But if this procedure fails Valsalva maneuver can be used. When this method is used it can also cause auditory damage and can increase further complications, so sometimes swallowing or yawning is preferred. It is commonly done against a closed glottis or against external pressure measuring device eliminating the pressure on the Eustachian tubes. Straining or blowing against resistance like blowing up a balloon can lower the blood pressure and cause dizziness and fainting.
The patient is connected to the heart monitor and echocardiograph or a stethoscope is used to monitor the heart. An indwelling needle is used sometimes for measuring accurate pressures, depending on whether it is done for corrective and diagnostic purposes. The physiological response includes four phases:
- Initial pressure rise
- Reduced venous return and compensation
- Pressure release
- Return of cardiac output.
The deviation from these normal phases indicates damage to the heart or abnormal autonomic control of the heart. It should not be performed in patients suffering from coronary artery disease or suffered from a heart attack.
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