Valsalva Maneuver

Valsalva Maneuver Definition

The Valsalva maneuver is a forceful exhalation by closing the mouth and nose.

This is performed by attempting a moderately forceful exhalation through a closed airway, by closing the mouth and pinching nose with fingers. This technique was first used by a seventeenth-century general physician named Antonio Maria Valsalva. He had used this technique to expel pus from the patient’s ear.

In various natural incidence, we may be using a variation of the Valsalva maneuver where the forced exhalation is tried through closed glottis with the mouth or nose is open or closed in an unintentional way.The general instances where unintentional Valsalva maneuver may occur are sneezing, coughing, passing stool during constipation, vomiting, lifting heavy objects or getting up from the bed.

Phases of Valsalva maneuver

The forceful exhalation during Valsalva maneuver affects the intrathoracic pressure which may, in turn, affect the cardiac output and heart rate. In general, during the forceful exhalation process, an increased amount of pressure is experienced in the nasal chamber, thoracic region, ear tubes along with inner and middle ear, mouth cavity, abdomen, and rectum.

Stage 1: During the first stage of blowing the internal pressure rises in the chest and abdomen area, resulting in the increase in the stroke volume and mean arterial blood pressure. The increased pressure causes low blood flow in the right atrium and a drop in the heartbeat.

Stage 2: In the second stage due to increased pressure in the chest the blood flow output of the heart is reduced, causing low stroke volume leading to reduced mean arterial blood pressure. Return to a systemic flow of the blood to the heart is reduced and the pulse rate of the person is increased.

Stage 3: This is the relaxation phase, where the intra-thoracic pressure decreases, causing the arteries to dilate and widen up and the venous blood again re-enters the heart and thus the cardiac output and blood flow in the body increases.

Stage 4: This stage is marked by a sudden increase in the cardiac output caused as the blood starts entering the heart against the impending pressure. With a slight initial rise in the heart rate and blood pressure, after some time pulse rate comes back to the normal state.

Valsalva maneuver Uses and Benefits

The Valsalva maneuver is beneficial in lots of incidences if followed properly. This technique may help in equalizing the ear pressure when performing activities like scuba diving, flight landing, parachuting etc. The forceful exhalation also helps in expelling the pus from the infected ear. Also, the technique works well in people suffering from ringing ear syndrome.

The process is also helpful in maintaining the outside air pressure and ambient pressure in persons suffering from Eustachian tube dysfunction. The Valsalva maneuver process may be useful in clearing the mucus and relieving the patients from sinusitis pain. Sometimes this is also useful to prevent hiccups and helping with passing stools in people suffering from various bowel syndrome.

Valsalva maneuver as a part of the fitness routine

Valsalva maneuver is often used in various fitness regimes, especially weightlifting. The technique not only helps in improving breathing while weightlifting but also increases safety parameters. Valsalva maneuver helps in avoiding spine injuries during heavy weight lifting and other activities like squat, bench press, roman deadlift, clean and jerk and many others. Performing Valsalva maneuver during these activities helps in releasing the pressure from the intervertebral disc providing support to the core musculature of the spine.

The Valsalva maneuver has to be followed properly in which the person is asked to inhale before lifting the weight, holding the breath for the most difficult time and then exhaling to lift the weight. Doing this creates power pressure in the abdominal and thoracic cavities which in turn, increases the core output potential of the person and also provides support to the lower spine thus, preventing any injury.

Valsalva maneuver as a Diagnostic Tool

Neurology: Valsalva maneuver is used in diagnosing various nerve tissue injury in the cervical spine region. The process increases the pressure in the intra-spinal region, which may cause an increased pain suggesting an impingement in the nerve tissue or the vertebral disc region. If the person performing Valsalva maneuver exercise experiences intolerable head pain it might be suggested that the person is suffering from Arnold-Chiari malformation.

Similarly, during the Valsalva maneuver the abdominal and intrathecal pressure increases, which often leads to pain in the secondary lesions or herniated discs or in the gaps in the spinal canal. In such cases, immediate medical attention is required.

Urogenital: This technique may also be helpful in diagnosing various urogenital disorders like intrinsic sphincteric deficiency and pelvic organ relapse.

Heart: This technique is mostly used as a diagnostic tool to identify various heart abnormalities in combination with an echocardiogram. The diagnostic technique is based on the fact that when the person performs forceful exhalation keeping the mouth and nose closed, there is an increase in pressure in the thoracic region causing changes in the normal blood flow and blood pressure.

The changes in the rate of the blood flow and pressure may be studied and compared with the normal person to find out any anomaly associated with the patient’s heart. The Valsalva maneuver is often used in correcting the heartbeat rhythm. The increase in the pressure causes the changes in the blood flow rate through the heart and thus correcting its blood pumping rate and beat slowly.

Apart from above-mentioned disorders, there are several other diseases where the Valsalva maneuver technique may assist in diagnosis such as a hernia; pelvic floor weakness; ETD or Eustachian tube dysfunction; cervical or lumbar radiculopathy; congestive heart failure; heart murmurs; various ailments related to an autonomous nervous system and much more.

Complications associated with Valsalva maneuver

• Valsalva maneuver may sometimes cause emergency conditions during a bowel movement. Prolonged straining during stool passing may lead to heart attack in extreme cases or the patient may faint away, which is often referred to as defecation syncope.
• A heart attack may be caused due to increased pressure during Valsalva maneuver, causing a drop in the blood pressure along with lowering of heart rate and vasodilation of arteries. The pressure also causes irritation of the nerves in the rectal region, which in combination with lower heart rate and blood pressure may cause heart attacks.
• Valsalva maneuver may also cause various complications during weight lifting, if not performed correctly. The person may faint away due to increased pressure and lower heart rate and blood flow. In some cases, temporary fading away or memory loss may occur due to extreme pressure. Excessive blood clotting, heart attack, brain stroke are few other medical emergencies which need immediate attention.
• Valsalva maneuver during bowel movement or pregnancy or severe coughing or weight lifting may in some situation lead to bleeding in the retinal membrane. This is often associated with temporary loss of eyesight, blurring of vision, redness of the eye. Clinically, this condition is referred as “Valsalva retinopathy”. Individuals suffering from Idiopathic thrombocytopenia are supposed to be at a greater risk of having Valsalva retinopathy.
• A few other side effects of Valsalva maneuver include a hernia; glaucoma; heart attack; sudden death; a headache, dizziness, vertigo, and fainting.

References:

http://www.onlinejacc.org/content/56/16/1352

http://medical-dictionary.thefreedictionary.com/Valsalva+maneuver

http://ajpheart.physiology.org/content/287/2/H798

https://www.ncbi.nlm.nih.gov/pubmed/6565684

http://www.breathing.com/articles/valsalvas-maneuver.htm

http://www.sciencedirect.com/topics/neuroscience/valsalva-maneuver