robin082006
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Can anyone explain?
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| anu_millenium
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valsalva maneuver is when we ask pt to blow air against closed mouth n nose...it tests the patency of eustacian tube
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| mjl1717
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There is more physio the that.
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| mjl1717
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1)Expiratory pressure against a closed glottis
2)decreases cerebral blood flow(should reproduce ischemic symptoms )
3)decreases L&R ventricular filling
4)Can help dx tussive syncope
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| robin082006
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thank you
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| icefires
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valsalva is not done as generally believed "valsalva maneuver is when we ask pt to blow air against closed mouth n nose"
pt is asked to blow out a stiff rubber tube, or in some cases the b.p apparatus can be used.
it inc . the parasympathic tone,dec heart rate.
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| mjl1717
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How do you tell pt to close ther nose?
But seriously: "Bare down as if you are going to have a bowel movement" 
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| ssrpk
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What happens during this maneuver is that, when one tries to expell out air forcefully with a closed glottis, there is generation of high +ve intrapleural pressure , which impedes right sided venous return and initially compresses the lungs which squeezes out the blood which was previously accumulated during inspiration, this initially results in inc. in venous return to left heart and subsequent CO and heart rate goes down, but after some time due to resistance across pulmonary vasculature, venous return to left heart decreases as well along with left sided cardiac output, and heart rate shoots.
Valsalva Maneuver is particularly helpful in evaluation of valvuar disorders, eg: it differentiates between ejection murmur of aortic stenosis and HOCM.
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| reet
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good explaination ssrpk.........thanks
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| drk1980
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ssrpk, thanks!
could you plz elaborate on wht wud the signs be before and after valsalva in HOCM? also like aortic stenosis is there any condition we need to know to distinguish from HOCM by valsalva? as i understand, you hv graduated from step1 and are now posting answers to help the rest of us out...thanks indeed!!
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| ssrpk
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this forum actually gave me the right directions when i started my step1 prep a yr back, let's just say i need directions again. 
anyway, there are basicaly two kinds of murmurs, systolic and diastolic, which occured in different settings..... and there are some overlaps, where two or more conditions produce similar kinds of murmurs. This is where we perform certain maneuvers that helps to differentiate among them.
Most important are a)valsalva maneuver b)squatting
the basis is that , during valsalva preload in left ventricle decreases while during squatting it increases as does stroke volume.
certain murmurs gets exagerrated while there is large volume in the ventricle (aortic stenosis) while others get exagerrated upon decrease in volume (HOCM) which is elicited with the help of these maneuvers.
A good memory tool is to learn the following facts:
- All murmurs of stenosis and regurgitation due insufficiency are exagerrated during squatting (increase blood flow), and their intensity decreases upon performing valsalva (decrease blood flow).
- Exceptions to the rule above are: Hypertrophic obstructive cardiomyopathy and mitral valva prolapse. HOCM & MVP murmurs are exagerrated with valsalva while gets diminished with squatting.
HOCM: Valsalva decreases blood volume in left ventricle and therefore bring the hypertrophied septum in close apposition with the ventricular wall & mitral valve leaflet (leading to obstruction), thus enhancing the ejection murmur, however upon squatting, increase blood volume overcome the resistance offered by the septum and thus the murmur diminishes.
MVP: Valves are floppy (extra large in size) and therefore the surfaces don't appose well when there is low blood volume (valsalva) which permits small amount of blood to regurgitate and thus produce mid-systolic click, however during squatting as blood vlume increases and ventricles enlarge which stretches the mitral valve ring, the cusps are better able to appose each other and thus prevent functional regurg.
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| drk1980
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this was very helpful! although i feel you are already in the right direction, i hope you get what you are looking for ...
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| mjl1717
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Great ssrpk! Seems like there is a big difference in having a definition of Valsalva versing mastering or manipulating it.
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| simi
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thanks for the explanation ssrpk!
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| sturge_weber
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excellent ssrpk... awesome explanation...
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| Geroo
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I'm confused isn't squatting supposed to decrease venouse return and decrease ventricular volume??
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| drk1980
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by squatting one is pumping all the blood out of the veins and tht wud by mechanical action Increase venous return.....
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| Geroo
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it's mentioned in goljan notes under MVP that squatting decreases venous return and ventricular volume.that's confusing.
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| docarchana
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ARTERIAL PRESSURE HEART RATE
phase 1 increased no change
phase 2 decreased reflexly increased
phase 3 decreased reflexly increased
phase 4 increaesed reflexly decreased
The above are the 4phases of Valsalva Maneuver
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| Leopard
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docarchana wrote:
ARTERIAL PRESSURE HEART RATE
phase 1 increased no change
phase 2 decreased reflexly increased
phase 3 decreased reflexly increased
phase 4 increaesed reflexly decreased
The above are the 4phases of Valsalva Maneuver
Are you sure that in phase III BP is decreaased ???
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| docarchana
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leopard, the above one is the explanation given in kaplan qbank.
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