What is the Valsalva test and when is it used

The basis of this diagnostic technique is such a phenomenon as a change in the indicator of intra-abdominal and intrathoracic pressure, which develops in a patient with attempts. The reason is the change in the hemodynamics of the vascular bed. Conditionally diagnostic examination is divided into 4 phases. The first 2 of them correspond to the time when the patient is asked to push.

As a result of tension, a mechanical process of spasm of large vessels of the central and peripheral venous channel occurs, which in turn leads to a decrease in the volume of blood flowing directly to the heart. Clinically, this is manifested by a drop in blood pressure due to a decrease in the amount of blood leaving the heart. A reflex increase in heart rate also occurs.

The subsequent phases are a period of relaxation. At this time, the volume of blood flowing directly to the heart is normalized. The result is an increase in cardiac output and an increase in blood pressure. As a result of nerve impulses, which are activated from nerve endings located in the carotid artery, and transmitted through the brain to the vagus nerve, resulting in a decrease in heart rate. This is how a healthy body reacts to an increased load, as a result, the reaction will be considered negative.

What does a positive test look like? With the development of a pathological process in the region of the heart, for example, after a transferred myocardial infarction, structural changes in muscle tissue occur. As a result of this, the heart muscle is no longer able to change the rhythm of contractions in a certain time in response to impulses sent by the vagus nerve. This is recorded as a result of testing.

Another effect that manifests itself normally with attempts is an increase in pressure in the venous bed of the lower extremities. If pathological processes develop in the area of ​​the valves of the femoral and ankle vessels, during this test, a retrograde blood flow will be detected, that is, it begins to move along the vessels in the opposite direction.

A similar test can be applied in otolaryngology, however, here it will have not a diagnostic, but more, a therapeutic effect and will be referred to as a test rather than a test. Patient straining, in addition to affecting the organs of the cardiovascular system, causes an increase in pressure in the nasopharynx.

This in turn leads to the opening of the so-called Eustachian tubes, an increase in pressure directly in the middle ear. If an inflammatory process with suppuration develops here, then increased pressure helps to break through the eardrum with the expiration of purulent masses out. As a result, the acute period of inflammation subsides, which leads to a decrease in the pain symptom.

The basis of this test is a deep breath followed by exhalation. However, in the diagnosis of various pathological processes, the research methodology is slightly different:

  1. In cardiological practice, the load and relaxation of the patient is carried out not only under the supervision of a doctor, but also using special diagnostic equipment. During the examination, the patient can be both lying and sitting. He is offered to take a deep breath, and then, slowly, exhale (the time is regulated) into a narrow mouthpiece. Then it is proposed to restore breathing. The entire study period is controlled by a blood pressure indicator and electrocardiography is performed.
  • The Valsalva test in pathological processes in the vascular bed is preceded and ends with a second ultrasound examination. When testing, the patient is in a standing position, offer a deep breath, and then exhale through the nose. The mouth should be closed. As a result, muscle tension occurs in the chest and abdomen. It is during the patient’s relaxation period that the state of the vascular bed of the lower extremities is examined, that is, a Doppler study is performed.
  • In urological practice, a test according to the Valsalva method is carried out with almost any routine examination of men. It is intended for the diagnosis of a disease such as varicocele. It is characterized by expansion of the veins in the testicles. For testing, the patient is offered to take a deep breath and hold his breath for a while. It was at this time that the doctor made a palpation examination of the scrotum slightly higher than the testicles.

Valsalva’s test is a specific breathing technique used in medicine to determine the performance of the heart and blood vessels, the autonomic nervous system, and the auditory analyzer.

change in pressure inside the body when taking Valsalva

The patient takes a deep breath, and then a smooth and deep exhale into the mouthpiece with a narrow hole. After relaxation, it restores breathing. During the procedure, the pulse and blood pressure level are continuously recorded. The analysis of the cardiogram is confirmed by ultrasound data of blood vessels. The patient gets up, inhales and exhales with his mouth closed. Instead of the usual exit, muscle tension in the chest and abdomen occurs.

  1. The first phase is exhalation. It lasts 3 seconds and is accompanied by an increase in pressure in the chest and abdominal cavities.
  2. The second phase is tension: hypotension, tachycardia, increased peripheral vascular resistance. The blood supply of the heart becomes maximum, the transparency of the lungs increases. This phase lasts 6-7 seconds.
  3. The third phase is the cessation of exhalation and the beginning of a period of relaxation. Blood pressure drops sharply, heart contractions are reduced and deepened. The transparency of the lung tissue and the size of the heart become normal.
  4. The fourth phase – the end of the relaxation period: rise in blood pressure above the original, bradycardia, peripheral vasodilation, restoration of venous return and cardiac output.

change in blood pressure (BP) and heart rhythm (heart rate) according to the phases of the Valsalva test

According to the cardiogram, the length of the RR intervals is determined. The ratio of the longest and shortest intervals is called the coefficient, which is considered to be diagnostically significant. In healthy people, it is above 1,7. If it is between 1.3 – 1.7, the state is borderline. A value below 1.3 indicates a high mortality rate from heart failure.

Valsalva’s test, when used in cardiology, also allows you to determine myocardial tonus and changes in heart size with fluctuations in hilar pressure.

In cardiology, the test is carried out under the supervision of a doctor while lying or sitting with the simultaneous registration of ECG and blood pressure. The patient is asked to inhale deeply, then gently exhale deeply into the mouthpiece with a narrow hole for 15 to 20 seconds. Then you can relax and breathe. The following is an analysis of the cardiogram.

In vascular surgery, a test is performed before and after an ultrasound examination of the vessels and legs. The patient is asked to stand up, inhale and try to exhale with his mouth closed. That is, the exhalation itself is not carried out, instead of it there is straining and tension of the pectoral and abdominal muscles. Immediately conduct a Doppler – a study of the vessels of the lower extremities to assess the blood flow in the veins.

Reception of Valsalva is carried out in a similar way – inhaling and trying to exhale with straining. Passengers are advised to inhale, cover their nose and mouth with their palms and exhale not by mouth, but trying to push air into their ears.

The basis of this diagnostic technique is such a phenomenon as a change in the indicator of intra-abdominal and intrathoracic pressure, which develops in a patient with attempts.
The reason is the change in the hemodynamics of the vascular bed. Conditionally diagnostic examination is divided into 4 phases. The first 2 of them correspond to the time when the patient is asked to push.

As a result of tension, a mechanical process of spasm of large vessels of the central and peripheral venous channel occurs, which in turn leads to a decrease in the volume of blood flowing directly to the heart. Clinically, this is manifested by a drop in blood pressure due to a decrease in the amount of blood leaving the heart. A reflex increase in heart rate also occurs.

The subsequent phases are a period of relaxation. At this time, the volume of blood flowing directly to the heart is normalized. The result is an increase in cardiac output and an increase in blood pressure. As a result of nerve impulses, which are activated from nerve endings located in the carotid artery, and transmitted through the brain to the vagus nerve, resulting in a decrease in heart rate. This is how a healthy body reacts to an increased load, as a result, the reaction will be considered negative.

Another effect that manifests itself normally with attempts is an increase in pressure in the venous bed of the lower extremities. If pathological processes develop in the area of ​​the valves of the femoral and ankle vessels, a retrograde blood flow will be detected during this test, that is, it begins to move in the vessels in the opposite direction.

A medical study for varicose veins begins with a doctor’s examination, palpation and medical history. In addition to these methods, a Valsalva test may be needed, which allows you to determine the pathology of the vessels and the operability of the valve apparatus in the venous system.

At the first examination, the phlebologist determines the presence of “stars”, redness nodes and other changes. After the initial examination, this specialist often prescribes an ultrasound of the veins, which is a safe and painless diagnostic method, helping the doctor assess the general condition of the vessels, detect the presence of blood clots. An additional examination may be necessary with:

  • deep research method – ultrasound scanning (color duplex scanning);
  • studies of the direction of blood flow, blood flow velocity, blood pressure and volume – ultrasound scan (Dopplerography), this method makes it possible to see structural changes in the walls of blood vessels;
  • UZAS (ultrasonic angioscanning);
  • three-dimensional x-ray – spiral CT (computed tomography);
  • phlebographic research;
  • laboratory (blood test, which is very important) and other studies.

Test procedure for varicocele

The fact is that despite all the safety of the test, if there are contraindications, it can threaten a significant deterioration.

Self-testing of Valsalva is not recommended

If there are no contraindications, then the doctor conducts a test of Valsalva with varicocele, which is as follows:

  1. The patient lies down or sits down.
  2. It takes a deep breath, closing the nose and mouth.
  3. Fixes position 1-2 seconds.
  4. Then he breathes into a special tube, which is connected to a barometer to control the strength and frequency of respiration.

At this time, the specialist performs manual palpation of the testicles in the area above the scrotum and determines the presence of damaged vessels.

If the doctor finds certain pathological changes, then an ultrasound is prescribed to clarify the diagnosis.

At each professional examination of a man, urologists carry out a Valsalva test, which allows you to identify varicocele at the initial stage and avoid the harm caused by this pathology to the body. During the diagnosis of varicocele, the patient takes a deep breath and holds his breath. At this time, the doctor palpation examines the scrotum and testicles of the patient.

change in the blood supply to the scrotum with a Valsalva test

A Valsalva test performed during an ultrasound scan can detect a change in blood flow in the affected veins. The patient is asked to take a deep breath, inflate the abdomen as much as possible and tighten the muscles of the lower abdomen. The spermatic cords increase, on them elastic nodules are determined. These signs indicate the development of varicocele.

Valsalva test for vein pathology

Often, a Valsalva test is performed for patients with varicose veins. Failure of venous valves on the legs leads to regurgitation (reverse current) of blood when strained.
Valsalva’s test allows you to identify vascular pathology, determine the functional state of the valve apparatus and its reliability in the venous system. On inspiration, the venous blood flow is sharply weakened, with tension it completely disappears and intensifies on a subsequent exhalation.

During this test, the diameter of the vessels increases by about 50%. If there is insufficiency of the valves of the veins, the pressure in the vessels of the lower extremities rises, a retrograde blood flow occurs. The slow rate of reverse blood flow prevents the venous valve from closing. The Valsalva test helps to achieve the optimal blood flow velocity.

Valsalva’s test is a diagnostic method that is not always distinguished by informativeness and objectivity.
Abdominal muscles do not achieve sufficient tension in individuals:

  • Having flabby abdominal muscles,
  • Overweight
  • Physically weakened
  • Female.

Such patients undergo a modified test. Install the sensor in the place where the venous valve is located. The patient strains, and the doctor presses on the front wall of the abdomen around the navel. This allows you to determine the prevalence of venous reflux.

Another version of the modified test: after straining, the patient lies on his back, and the assistant raises his legs up at an angle of 45 ° for 15 seconds. The effectiveness of this method has been proven empirically.

Straining at maximum inspiration with a breath hold of 30-40 seconds leads to an increase in pressure in the tympanic cavity and the opening of the auditory tubes. Airflow enters the middle ear.

When conducting a diagnostic test of Valsalva
, the patient develops crackling, discomfort, discomfort in the organ of hearing. The otoscopic sign of this process is a characteristic noise that only a doctor can detect.

Purulent otitis media often ends with perforation of the eardrum and the release of pus. If there is swelling of the mucous membrane of the auditory tube, but its patency is preserved, when straining the patient feels a squeak, gurgle and noise in the affected ear.

Valsalva Reception (maneuver)
, in turn, helps to equalize the pressure in the cranial cavities with the pressure of the environment and get rid of unpleasant sensations. Valsalva’s maneuver is also used to remove inflammatory exudate from the middle ear.

Despite the fact that in the human body there are regulatory mechanisms that support the correct rhythm of heart contractions, sometimes due to diseases of the heart or other organs, rhythm disturbances develop, including tachycardia – an increase in heart rate. Heart palpitations can be physiological, for example, as a result of an adequate response to physical activity, and pathological, caused by serious diseases of the heart muscle.

In the latter case, it is important to evaluate the type of tachycardia and its prognostic value, in particular, the risk of developing sudden cardiac mortality. For this, doctors have developed entire systems of classifications, gradations and scales of risk factors, but this article will describe in more detail about the test and administration of Valsalva. The latter, moreover, with some types of tachycardia has a therapeutic effect, allowing you to quickly eliminate the unpleasant symptoms of a heartbeat.

To begin with, it is necessary to distinguish between the concept of “test” and “reception” of Valsalva. Valsalva’s test is a diagnostic measure used by cardiologists, vascular surgeons, ENT – doctors to diagnose diseases of the relevant organs. Valsalva’s reception is the patient’s actions that are aimed at creating high pressure in the middle ear cavity, chest and abdominal cavities.

These actions consist of a deep breath followed by a deep exhalation, with straining and holding the breath for 15 to 20 seconds. That is, the Valsalva test is based on the implementation of the same reception. The method was proposed by an Italian scientist in the 18th century and was used to cleanse the pus from the middle ear cavity as a result of perforation of the eardrum under the influence of forced air in the throat. In the middle of the 20th century it was used in obstetrics during the period of attempts (period of expulsion of the fetus).

Evaluation of results

Both the appointment for examination by the “Valsalva test” method and its interpretation are carried out only by the attending physician, taking into account the main and associated diseases. This study is especially carefully prescribed in cardiology practice. However, the patient may ask, on the basis of what data the cardiological diagnosis is confirmed or refuted.

  1. With the help of an electrocardiogram, 2 main diagnostic indicators are determined – these are the shortest and longest intervals between ventricular contractions.
  2. Compare the ratio of their values ​​with the standard, which should exceed 1,7.

In the event that this indicator is less than the standard, but does not fall below 1,3, then the patient will be told that he is in the so-called borderline state. And with a lower value, it is said that there is an increased risk of death due to problems in the heart. The main reason for this condition is considered to be a decrease in the nervous response to adequate stimulation of the vagus nerve branch.

If we talk about the criteria for assessing the patency of the vascular bed of the lower extremities, the diagnostic technique has significant differences from the above. Here, the calculation of the result is based on Dopplerography data, which shows the speed of blood flow through the vascular bed. In the case when the indicator obtained during the study exceeds 30 cm / s, the doctor claims an increase in pressure in the bloodstream. This is a diagnostic criterion for the development of pathology.

When assessing the risk of sudden cardiac death in people with organic heart damage, the result is interpreted as follows. On the cardiogram, the longest and shortest interval between two ventricular contractions is calculated (interval R – R). The ratio of long to short should be more than 1.7.

When assessing the patency of the veins of the legs, the indicators obtained as a result of ultrasound with Doppler are calculated. If the retrograde blood flow velocity is more than 30 cm / s and lasts more than 1 second, this indicates the inability of the veins to hold blood with an increase in pressure. In this case, the sample is considered positive.

Doctor therapist Sazykina O.Yu.

Both the appointment for examination by the “Valsalva test” method and its interpretation are performed only by the attending physician, taking into account the main and associated diseases. This study is especially carefully prescribed in cardiology practice. However, the patient may ask, on the basis of what data the cardiological diagnosis is confirmed or refuted.

  1. With the help of an electrocardiogram, 2 main diagnostic indicators are determined – these are the shortest and longest intervals between ventricular contractions.
  2. Compare the ratio of their values ​​with the standard, which should exceed 1,7.

The result of the procedure can be of two types: positive and negative.

Border states can also be determined that indicate a person’s tendency to ailment or its presence at the initial stages of development.

A positive test indicates the presence of pathology, a negative test indicates its absence

Next, consider what these are the positive and negative tests of Valsalva and what they mean.

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Positive test

Before deciding on what a positive test of Valsalva means, we will touch on the anatomical structure of veins.

There are special valves in the venous system that ensure normal blood flow. When these clans start to malfunction, blood is thrown backwards, which leads to the formation of stagnant phenomena.

So, if a positive test is determined, then this indicates a malfunction of the valve system.

In addition, pathological reverse blood flow (determined when performing the Valsalva test during an ultrasound scan) can speak of problems with the vessels.

A positive diagnostic result indicates the presence and development of varicocele

Based on the results of the procedure, a specialist can prescribe further examinations or choose a medication regimen.

Negative test

A negative result of this examination indicates that no anomalies were found in the test vessels.

In such a situation, bloated veins are not determined, which means that the process of blood circulation and the functioning of venous valves are normal.

Indications for the Valsalva test

The technique is used in various fields of medicine

  • determination of patency of the auditory tubes;
  • diagnosis of tachycardia;
  • diagnosis of varicocele and the severity of baroreflex of the genital area;
  • assessment of the venous valvular system of the legs and determination of varicose veins;
  • determination of autonomic nervous system dysfunction;
  • assessment of the risk of death after a heart attack.

In addition, the Valsalva technique helps to eliminate the unpleasant sensations of divers when diving to a depth.

Also, this technique will help reduce pressure in the middle section of the auditory analyzer during take-off / landing of the aircraft or with a sharp jump in atmospheric pressure.

The first is appointed by a specialist for examination and is carried out in the hospital, the second is designed to eliminate discomfort, and can be performed independently.

What is the Valsalva test based on?

The action of the method is based on a change in pressure in the chest and abdominal cavities when straining the patient. As a result, hemodynamics changes (blood flow through the vessels). All processes can be divided into 4 phases. The first two phases correspond to the period of tension, the last two to the period of relaxation after straining.

First, there is a mechanical collapse of large veins, which reduces the flow of blood to the heart. This causes a decrease in cardiac output, blood pressure and a reflex increase in heart rate. At the beginning of the patient’s relaxation, the blood flow to the heart is restored and increases, blood flow to the aorta and an increase in blood pressure increase.

Here, baroreceptors located in the carotid sinus (a section of the carotid artery) are connected, which capture high blood pressure and send signals to the brain along the nerves from the carotid artery. In the brain, signals are transmitted to the nuclei of the vagus nerve, whose branches, acting on the heart, slow down the frequency of its contractions. This sequence of reactions occurs in a healthy heart and blood vessels.

If there is a pathological process in the heart, for example, changes after myocardial infarction, then the heart muscle is not able to change the rhythm of its contractions in response to stimulation of the vagus nerve. Such a heart is probably already worn out and more at risk of developing asystole (stopping), and, as a result, the onset of clinical death.

In addition, straining causes an increase in pressure in the veins of the lower extremities. In case of failure of the vein valves of the thigh and lower leg, the blood moves in the opposite direction (retrograde blood flow), which should not be normal.

In otorhinolaryngology, straining during deep exhalation has a different effect – there is an increase in pressure in the closed nasopharynx, which leads to the opening of the auditory (Eustachian) tubes and an increase in pressure in the middle ear cavity. This in the case of accumulation of pus in the middle ear can cause a breakthrough (perforation) of the eardrum with the release of purulent masses to the outside.

Indications for prescription

As a diagnostic technique, the Valsalva technique can be prescribed for the following pathologies:

  • for the diagnosis of tachycardia, in this case, it is combined with simultaneous electrocardiography and blood pressure measurement;
  • with myocardial infarction, this method helps to predict the likelihood of death;
  • diagnostics will help assess the condition of the venous valves of the lower extremities, the study is carried out in combination with dopplerography;
  • you can use the Valsalva test with varicocele as an emergency diagnosis of pathology in the early stages of its development;
  • in otolaryngology, such a technique will help diagnose the presence of impaired hearing a >

The Valsalva technique can be used to stop various pathological conditions:

  1. In cardiological practice, for patients with certain types of tachycardia, for example, sinus or supraventricular, doctors recommend in such a simple way to stop an attack of heart palpitations.
  2. When scuba diving to great depths, this technique will help combat the unpleasant sensation that occurs due to increased pressure in the middle ear.
  3. Similarly, you can remove the difference inside the ear pressure when the plane takes off or lands on the ground.

Possible contraindications

Immediately determine that it is unacceptable to use the Valsalva technique to stop an attack of a heartbeat when combined with pain in the heart, a drop in blood pressure or the development of suffocation. In this case, a sick person needs to call a doctor as quickly as possible.

As a diagnostic study, samples according to the Valsalva method are not prescribed for the following diseases:

  • patients who are in an acute stage of a heart attack or stroke;
  • when diagnosing a formed vascular thrombus in the area of ​​large arteries;
  • if there is a blockage of the veins of the vascular bed of the legs;
  • in acute surgical pathologies requiring immediate surgery;
  • some eye diseases are contraindicated, for example, such as proliferative retinopathy;
  • any infectious pathology, especially one that is accompanied by a fever;
  • with any chronic disease that is in the acute stage.

The Valsalva test is prescribed by a strictly attending physician for the purpose of a specific study and diagnosis. It is not recommended to conduct it on your own, only under the supervision of a specialist.

  • patients who are in an acute stage of a heart attack or stroke;
  • when diagnosing a formed vascular thrombus in the area of ​​large arteries;
  • if the vascular bed of the legs has occurred;
  • in acute surgical pathologies requiring immediate surgery;
  • some eye diseases are contraindicated, for example, such as proliferative retinopathy;
  • any infectious pathology, especially one that is accompanied by a fever;
  • with any chronic disease that is in the acute stage.

Medical tests and studies do not come to us from nowhere. Before they become public knowledge, they undergo many tests and checks, and only then they begin to serve people for the diagnosis of various diseases. Valsalva’s test is not as popular as, for example, a clinical blood test. This test is used for narrowly targeted diagnostics. Especially often, a test is done with varicose veins and some other diseases.

Valsalva test – historical information

Otherwise, this test is called Valsalva stress. This test is named after the famous anatomist Antonio Maria Valsalva. Initially, the test was aimed at removing pus with otitis media from the middle ear. But today it is used by drivers, aircraft passengers, doctors in the treatment of varicose veins and other diseases.

The method consists in the fact that a person inhales forcefully, provided that his mouth and nose are closed. Often this test is prescribed along with other examination methods. This is done in order to make a correct and accurate diagnosis. The sample is informative when applied with ultrasound and an electrocardiogram.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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