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Valsalva Maneuver

Valsalva Maneuver is a technique that involves forced expiratory efforts wherein the person forcefully exhales while keeping the mouth and nose closed. The Valsalva Maneuver is performed sometimes by fighter pilots by grunting and tightening abdominal muscles to prevent blackouts during high performance flying. Valsalva Maneuver is used in medical and fitness fields for different purposes. However, it is normally adopted as a diagnostic tool to evaluate the heart condition of the patient. Valsalva Maneuver is often used in conjunction with echocardiography to assess heart abnormalities.


Four different phases of hemodynamic changes occur while performing the Valsalva Maneuver.

1. At first phase of Valsalva Maneuver, pressure rises inside the chest cavity and pushes the blood out of the pulmonary circulation into the left atrium. This increases the blood pressure slightly.

2. During second phase, output of the heart is reduced and blood pressure falls, while the heart rate and peripheral vascular resistance are both increasing thereby raising aortic pressure.

3. The third phase involves releasing of breath which results in immediate drop in intrathoracic pressure. The compression of the heart chambers is eased out and the venous return is smooth, increasing the pre load.

4. During fourth phase, sudden increase in cardiac output and aortic pressure occurs due to rise in venous blood volume. As the intra-aortic pressure rises, heart rate reduces and also causes vagal (parasympathetic) stimulation.


Any deviation from these normal responses indicates abnormality of heart and autonomic nervous control of the heart. It is particularly useful in diagnosing left-sided heart failure and heart murmurs. If the patient is suffering from hypertrophic obstructive Cardiomyopathy, the murmur of the heart becomes louder with Valsalva Maneuver. In case of aortic valvular stenosis, the noise of the murmur decreases with Valsalva as less blood will be released through the aortic valve.


It also acts as a corrective measure, to treat abnormal heart rhythms or relieve chest pain. When Valsalva maneuver is carried out, the blood pressure of the patient spikes and thus allows the heart to respond by correcting its rhythm and beating more slowly.

This Maneuver is also used to treat particular ear disorders. It is in fact named after Italian physician-anatomist Antonio Maria Valsalva, who recommended it for clearing pus from an infected middle ear.


Valsalva maneuver is also useful to patients with multiple sclerosis as it helps them to empty the bladder completely. The Valsalva maneuver is also widely used in the field of fitness, particularly while performing lifts. The Valsalva Maneuver increases the intra-abdominal pressure, providing more support for the back during lifts.


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Collection of Pages - Last revised Date: December 12, 2017