Valsalva maneuver

The Valsalva maneuver, even Valsalva pressing pressure test, Valsalva maneuver or Valsalva method (after Antonio Maria Valsalva, 1666-1723 ) is a medical procedure. It is used for example to check the Barorezeptorenreflexes or to ventilate the middle ear and in studying of leg veins with ultrasound. He will also, for example, performed by patients who suffer from heart palpitations to normalize the impact rate of the heart again.

Execution

The subject tries to exhale vigorously, while he zuhält the nose for about 10 seconds and closes the mouth. He clamped to the respiratory muscles and abdominal muscles. Thus, the air pressure in the airways is increased by closing the airway and tension of the respiratory muscles ( by attempted exhalation ).

Instead of the nose and mouth cover her, it is also possible ( glottis ) to exhale against a closed glottis or close the mouth and nasal cavity, as in the articulation plosive consonants by the tongue and velopharyngeal closure.

On examination of the eardrum to ventilate the middle ear and the Valsalva maneuver but must necessarily involve holding one's nose and open glottis and velum be performed because the pressure increase is not otherwise forwarded into the middle ear.

Applications

• For pressure equalization in the middle ear: About the eustachian tube occurs during Valsalva maneuver to equalize the pressure between the nasopharyngeal space and the middle ear. In intact eardrum bulges this point outwards, which can be observed by means of an ear funnel. It is used eg for flights (see pressurized cabin ), lift or cable car rides, or when tubal catarrh and effusion. Divers contact him regularly to adjust the middle ear pressure to the water pressure at to avoid barotrauma.

• On examination of the leg veins: The Valsalva maneuver results in the leg veins, that they expand and reduces the flow rate of the blood in the veins until the blood flow suspended. This can be represented with both color Doppler and with PW Doppler. (For a venous insufficiency of the blood flow does not stop and retrograde. ) Once the test is completed, the blood flows at an increased rate into the vessel. Thrombosis can also be induced by means of the Valsalva experiment, no blood flow.

• For self- treatment by patients with occasional bouts of tachycardia, in which the resting ECG, echocardiography and other diagnostic measures unobtrusively (without pathological findings) Me: The pressure in the thoracic cavity thereby increases and causes a halt, or significant decrease in venous return to the right heart or right atrium and ventricle. The stroke volume of the right ventricle is lower. The increased pressure in the entire thorax, however, give more blood to the pulmonary veins into the left ventricle, so as long as there is an increased stroke volume is delivered to the "stock" is used in the pulmonary veins. Not loosen the situation, then a collapse.

• On auscultation in hypertrophic cardiomyopathy ( HCM): In hypertrophic cardiomyopathy, which is associated with a thickening especially the left ventricle, one can hear a systolic pressure jet noise on auscultation of the heart over the Erb point, while the patient is the Valsalva maneuver performs. This is most likely explained by the fact that there is an increase in the pressure differences in the left ventricle during the compression test, which is characteristic of the HCM. The blood flow along the narrowed outflow tract in the left ventricle forms the pressing jet noise. Thus, the Valsalva test pressing are used to delineate a systolic heart murmur other typical causes of hypertrophic cardiomyopathy.