is performed by moderately forceful attempted exhalation againsta closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up aballoon. Variations of the maneuver can be used either in medical examination as a test of cardiac function andautonomic nervous control of the heart, or to "clear" the ears and sinuses (that is, to equalize pressure between them)when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or aviation.The technique is named after Antonio Maria Valsalva,
a 17th-century physician and anatomist from Bolognawhose principal scientific interest was the human ear. He described the Eustachian tube and the maneuver to test itspatency (openness). He also described the use of this maneuver to expel pus from the middle ear.A modified version is done by expiring against a closed glottis. This will elicit the cardiovascular responsesdescribed below but will not force air into the Eustachian tubes.
Blood pressure (systolic) and pulse rate during a normal response to Valsalva
s maneuver.Forty millimeter mercury pressure is applied at 5 seconds and relieved at 20 seconds.
The normal physiological responseconsists of four phases.
1.1.Initial pressure riseOn application of expiratoryforce, pressure rises inside thechest forcing blood out of thepulmonary circulation into theleft atrium. This causes a mildrise in stroke volume.2.2.Reduced venous return andcompensationReturn of systemic blood to theheart is impeded by the pressureinside the chest. The output of the heart is reduced and strokevolume falls. This occurs from 5to about 14 seconds in theillustration. The fall in stroke volume reflexively causes blood vessels to constrict with some rise in pressure(15 to 20 seconds). This compensation can be quite marked with pressure returning to near or even abovenormal, but the cardiac output and blood flow to the body remains low. During this time the pulse rateincreases (compensatory tachycardia).3.3.Pressure releaseThe pressure on the chest is released, allowing the pulmonary vessels and the aorta to re-expand causing afurther initial slight fall in stroke volume (20 to 23 seconds) due to decreased left ventricular return andincreased aortic volume, respectively. Venous blood can once more enter the chest and the heart, cardiacoutput begins to increase.4.4.Return of cardiac outputBlood return to the heart is enhanced by the effect of entry of blood which had been dammed back, causing arapid increase in cardiac output (24 seconds on). The stroke volume usually rises above normal beforereturning to a normal level. With return of blood pressure, the pulse rate returns towards normal.