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1 3rd March 20:21
mxsmanic
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Default Exactly what is a Valsalva maneuver?


I see lots of references to Valsalva maneuvers, but I can't find a
precise definition.

What exactly characterizes a Valsalva maneuver, and why is it important
to the cardiovascular system? In particular, how do I know if I am
doing this, and why is it said to be a strain on the heart? All the
sources I've looked at talk about it as though the reader already knows
exactly what it is (and I suppose most readers do, although I don't), so
I'm getting frustrated trying to figure out what is being described by
this term.

I get the impression that there is a "classic" Valsalva, and then there
are other actions that work in the same way or have the same effect on
the cardiovascular system and heart. So what are they? Anyone care to
give a precise description?

Finally, is this maneuver (or allied actions) dangerous for someone in
normal health? For somewith with hypertension? Heart disease?

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2 3rd March 20:22
dr. andrew b. chung, md/phd
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Default Exactly what is a Valsalva maneuver?


Holding one's breath and straining as one might do when constipated.

Blood pressure goes markedly up.


The latter two.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
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3 4th March 04:03
h.w. stockman
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Default Exactly what is a Valsalva maneuver?


Dr. Chung's working definition is pretty good... but there are some of us who
can perform a very good Valsalva without holding the breath.

When we strain in any way (say, by lifting weights, or by coughing), we may
isolate blood in veins of the muscles most used for the activity. When we
subsequently relax, the blood rushes back to the right side of the heart.

If you have a hole between the atria of the heart -- say from and ASD (atrial
septal defect) or a PFO (patent foramen ovale), Valsalva can be a risk factor
for stroke. Basically, a Valsalva is followed by a rush of blood back to the
right side of the heart, which temporarily pressurizes the right side relative
to the left. That pressure gradient can cause clots (normally present on the
left side, which handles return flow from the veins) to migrate into the right
atrium, where the clots may take a short trip to the brain or heart arteries.

I had a PFO closed by catheter 1 year ago. During the post-procedure echo, I
was asked to strain to perform a Valsalva; the release of the Valsalva then
causes the rush of blood back to the heart. The technicians were quite amazed to
find that I was able to talk and breathe while doing the Valsalva, and repeated
the test many times with the same results.
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4 4th March 04:03
mxsmanic
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Default Exactly what is a Valsalva maneuver?


Dr. Andrew B. Chung, MD/PhD writes:

What drives BP up? Is it a purely mechanical effect of the straining,
or what?

Is this why so many people seem to die of heart attacks while sitting on
the toilet?

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5 5th March 01:40
pochas
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Default Exactly what is a Valsalva maneuver?


http://www.healthatoz.com/healthatoz/Atoz/ency/valsalva_maneuver.html

The Valsalva maneuver is performed by attempting to forcibly exhale while
keeping the mouth and nose closed. It is used as a diagnostic tool to
evaluate the condition of the heart and is sometimes done as a treatment
to correct abnormal heart rhythms or relieve chest pain.

It's what you do to equalize your ears when the airplane lands.
It's what divers do when descending the water column to keep their
eardrums from rupturing.
It's taught as part of every diver certification class.

You hold your nose an blow gently.
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6 5th March 11:16
mxsmanic
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Default Exactly what is a Valsalva maneuver?


florald@bigfoot.com writes:


Codeine is a problem for me, too. For migraines I sometimes take
acetaminophen with 15 mg codeine, usually 1-3 over 24 hours. That's
really not much codeine, but it's enough to cause constipation, it
seems.

Fruit juices seem to help (sometimes too much!).

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7 5th March 11:17
h.w. stockman
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Default Exactly what is a Valsalva maneuver?


Traditionally, the "Valsalva maneuver is performed by attempting to forcibly
exhale while keeping the mouth and nose closed."
(http://www.hendrickhealth.org/healthy/001437.htm
same:
http://www.healthatoz.com/healthatoz/Atoz/ency/valsalva_maneuver.html ) ...

or, the "Valsalva maneuver is defined as expiration against a closed glottis
that increases the intrathoracic pressure by at least 30-40 mm Hg and lasts for
at least 10 seconds."

(http://www.carestudy.com/CareStudy/ef1/intro.asp)

Many scuba divers perform what they call the "Valsalva maneuver," to pop the
ears and equalize pressure in the sinuses, without closing the glottis.

When you lift a heavy weight above your head, you can close the glottis without
even realizing that you are holding your breath; the increase in intrathoracic
pressure helps stabilize the body for the extra "oomph" required during the most
strenuous phase of the lift.

When doctors actually measure arterial blood pressure (abp) during the Valsalva,
they see a distinct pattern in a normal individual. The abp starts with a
slight rise as the maneuver is started, then actually dips below average for
most of the maneuver. When the maneuver is released (the patient relaxes), abp
shoots way up. So yes, the real increase in abp occurs after the release, but
this increase is inevitable and cannot be dissociated from the maneuver itself.

Sometimes the patient is just asked to "strain," by tensing the abdominal
muscles, to produce the characteristic abp pattern of the Valsalva. In this
case, no constraint is placed on the patient's breathing or conversation, but it
is expected that if the patient is straining enough to produce the
characteristic abp pattern, the patient will not be able to talk. What my
doctors found was that I could strain my abdomen, produce the characteristic
abp, and talk and breathe the whole while.

A similar increase in abp can be achieved by coughing or sneezing. The main
idea is that any action that causes a sudden increase in abp can rip clots free,
or may cause a rupture of a blood vessel wall, or can cause a distension that
would crack calcified plaque.
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8 5th March 18:58
bob cardone
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Default Exactly what is a Valsalva maneuver?


Metamucil twice a day doesn't work ?

Bob
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9 6th March 05:12
mxsmanic
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Default Exactly what is a Valsalva maneuver?


Bob Cardone writes:

What does Metamucil contain?

I've tried to find straight psyllium, since pure fiber works pretty
well, but most preparations seem to contain other stuff, often with
additional laxative effect.

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