Valsalva attempt

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The Valsalva maneuver for examining the middle ear

The Valsalva test , also Valsalva pressure test , Valsalva maneuver or Valsalva method (after Antonio Maria Valsalva , 1666–1723) is a medical procedure. It is used, for example, to check the baroreceptor reflex or to ventilate the middle ear and to examine leg veins with ultrasound . He is also z. B. performed by patients suffering from palpitations to normalize the heart rate again.

execution

The test person tries to exhale vigorously while holding his nose and closing his mouth for about 10 seconds. In doing so, he tenses the respiratory muscles and abdominal muscles . This increases the air pressure in the airways by closing the airways and tensing the respiratory muscles (by trying to exhale).

Instead of holding your nose and mouth shut, it is also possible to exhale against a closed glottis or, as with the articulation of plosive consonants, to cause a velopharyngeal closure through the tongue .

When examining the eardrum and ventilating the middle ear, the Valsalva maneuver must be performed with the nose closed and the glottis and velum open, otherwise the increase in pressure will not be passed on to the middle ear.

Applications

  • When examining the leg veins: The Valsalva test causes the leg veins to widen and the flow of blood in the veins to slow down until the blood flow stops. This can be represented both with color Doppler and with PW Doppler . (In the case of venous insufficiency , the blood flow does not stop and is retrograde .) As soon as the experiment is over, blood flows into the vessel at an increased rate. In the event of a thrombosis , blood flow cannot be induced even with the help of the Valsalva experiment.
  • For self-treatment by patients with occasional attacks of palpitations , in whom resting ECG , echocardiography and other diagnostic measures remain inconspicuous (without pathological findings): The pressure in the thoracic cavity increases and causes a standstill or significant decrease in the venous return flow to the right heart or right atrium and ventricle . The stroke volume in the right ventricle decreases. Due to the increased pressure in the entire thorax, however, the pulmonary veins give more blood to the left ventricle, which means that an increased stroke volume is released there until the “supply” in the pulmonary veins is used up. If you don't resolve the situation, a collapse occurs .
  • During auscultation in hypertrophic cardiomyopathy (HCM): In hypertrophic cardiomyopathy, which is associated with a thickening especially of the left ventricle, a systolic press jet noise can be heard during auscultation of the heart above the hereditary point while the patient is performing the Valsalva maneuver performs. This can most likely be explained by the fact that during the pressing test there is an increase in the pressure differences in the left ventricle, which is characteristic of HCM. The flow of blood along the narrowed outflow path in the left ventricle forms the jet noise. The Valsalva press test can be used to differentiate a systolic heart murmur from other typical causes from hypertrophic cardiomyopathy.

See also

Individual evidence

  1. R. Kazi, p Triaridis, P. Rhys-Evans: A short biography on the life of the dedicated anatomist - Valsalva . In: Journal of Postgraduate Medicine 50, 2004, pp. 314-315.
  2. ^ JF Polak: Peripheral Vascular Sonography: A Practical Guide. 2004, ISBN 0-7817-4871-2 .
  3. T. Chatterjee, Ch. A. Nienaber: Dual series: Internal medicine. 2nd edition, Thieme-Verlag, Stuttgart 2009, ISBN 978-3-13-118162-6 .