Valsalva Maneuver – ABC CARDIOL

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Is Your "Dry" Patient Really Not Congested? Physiological Basis and Clinical Use of Valsalva's Maneuver in Heart Failure

Introduction

In 2003, Nohria et al. published a manuscript considered a game-changer in acute heart failure (HF) treatment. As by this manuscript, patients admitted with heart failure should be clinically classified into four hemodynamic profiles defined by the presence or absence of congestion and hypoperfusion. Congestion was defined by “recent history of orthopnea and/or physical exam evidence of rales, jugular venous distension, hepatojugular reflux, ascites, peripheral edema, left-ward radiation of the pulmonic heart sound, or a square wave blood pressure response to the Valsalva maneuver.”

More than 20 years after this publication, the Valsalva maneuver continues to be routinely used during clinical evaluation of patients admitted to the advanced heart failure service at the Brigham and Women’s Hospital (personal experience), where profiles were created and validated. However, despite the fact that clinical profile determination has become a routine procedure, few physicians have incorporated the Valsalva maneuver in their practices. To date, no study has compared the accuracy of the different clinical methods available for assessing congestion in patients with HF. Therefore, we should not categorize a patient as “dry” before all possibilities of congestion are excluded. It is possible that patients are being categorized as dry when, in fact, they have congestion that would only be identified by the Valsalva maneuver. Correct determination of hemodynamic profile is pivotal, as the existence of congestion and/or hypoperfusion guides the management of patients admitted with heart failure decompensation. This manuscript aims to review the physiological bases of the Valsalva maneuver, justifying and encouraging its use in clinical practice.

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The Importance of the Effective Valsalva Maneuver during Echocardiography in Hypertrophic Cardiomyopathy

Viviane Tiemi Hotta et al. Minna Moreira Dias Romano Silvio Henrique Barberato Marcelo Luiz Campos Vieira … Fábio Fernandes Marcus Vinicius Simões

The Valsalva maneuver (VM) was first described in 1704 as a forceful expiration against the closed nose and glottis.^, At that time, no observations of the circulatory effects were mentioned. In 1853, Weber et al. described the hemodynamic and circulatory effects related to the VM, and it has been widely used in cardiology since then. The initial applications of the VM focused on the investigation of cardiac autonomic reflex control.

Currently, the VM is recommended in echocardiography, in specific scenarios, such as in patients with hypertrophic cardiomyopathy (HCM), for evaluation of dynamic left ventricular outflow tract (LVOT) obstruction. Nevertheless, its execution varies greatly, and there is a lack of standardization of pressure control and time of execution.

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Is Your "Dry" Patient Really Not Congested? Physiological Basis and Clinical Use of Valsalva's Maneuver in Heart Failure

Introduction

The Importance of the Effective Valsalva Maneuver during Echocardiography in Hypertrophic Cardiomyopathy

Electronic Document Format (Vancouver)

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Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)