VALSALVA MANEUVER AS TEST OF CARDIAC FUNCTION PATIENTS WITH PULMONARY DISEASE

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Abstract
Sixty-four patients with various lung disorders were divided into 4 groups, depending upon the degree of right ventricular impairment according to clinical, roentgenographic, and electrocardiographic findings. The validity of the grouping was confirmed by intracardiac pressure measurements. The Valsalva maneuver, with airway straining of 30 to 40 mm of mercury for 7 to 10 seconds, was performed with simultaneous recording of intravascular pressures. In normal subjects, a pressure overshoot occurs in both pulmonary artery and peripheral artery, together with a bradycardia after cessation of airway straining. The pressure overshoot in the pulmonary artery and the bradycardia were absent more frequently in patients with right ventricular impairment. In contrast, a pressure overshoot in the brachial artery occurred despite right ventricular impairment. Measurement of peripheral artery pressure and heart rate at the bedside before and after a Valsalva maneuver may be useful as a screening test for right ventricular impairment and pulmonary hypertension. A normal peripheral artery pressure overshoot but absent bradycardia suggest right ventricular functional impairment. If both peripheral pressure and heart rate changes are abnormal, no further localization of the cardiac disease is provided by the Valsalva maneuver response.