How The Valsalva Maneuver Works

How The Valsalva Maneuver Works

Valsalva Maneuver: The Valsalva maneuver is functioned by moderately forceful attempted expiration against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while evacuating air out as if blowing up a balloon. Abnormalities of the manipulation can be used either in the medical examination as a test of cardiac function and autonomic nervous discipline 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 medicine, or air travel.

The capacity is named after Antonio Maria Valsalva, a seventeenth-century physician and anatomist from Bologna whose principal scientific interest was the human ear. He represented the Eustachian tube and the manipulation to test its patency (openness). He also represented the use of this maneuver to expel pus from the middle ear.

 How The Valsalva Maneuver Works

What Is Valsalva Maneuver

The Valsalva manipulation is a particular way of breathing that increases tension in the chest. It causes various developments in the body, including changes in the heart rate and blood pressure.

People may perform the manipulation regularly without knowing it. For illustration, they may use it when they push to initiate a bowel development.

However, this technique can also be beneficial when people use it intentionally as it can standardize heart cadences and help the ears to pop.

The specialist Antonio Maria Valsalva first represented the technique in the 1700s as a way to clear pus out of the ears.

To do the Valsalva maneuver, follow these steps:

  • Smell deeply and then hold your breath.
  • Imagine that the chest and stomach tendons are very tight and bear down as though straining to initiate a bowel movement.
  • Hold this position for a short time, usually about 10 seconds.
  • Breathe out effectively to release the breath rapidly.
  • Resume normal breathing.

An different method involves lying down and rushing into an empty syringe for 15 seconds.

The Valsalva manipulation creates numerous effects in the body because it builds up the pressure in the pleural cavity, known as the intrapleural pressure.

This heightened pressure can lead to the squeezing of the chambers of the heart and key blood vessels in the body, including:

  • the aorta, which is the major artery that pours oxygen-rich blood through the body
  • the vena cava, which is the major vein that returns blood to the heart

The compression of the aorta initially causes the blood pressure to rise. A sensor in the carotid artery, called the baroreceptor, detects the strengthened blood pressure.

What Is The Valsalva Maneuver

 What Is The Valsalva Maneuver

The Valsalva maneuver is a breathing technique that can be used to help diagnose a complication with the autonomic nervous organization (ANS). It can also be used to help restore a normal heart rate if your heart starts beating too fast.

Named after 17th century Italian specialist Antonio Maria Valsalva, the technique requires you to try exhaling when your airways are blocked. A version of the Valsalva maneuver can also be used to help balance the air stress in your ears.

In addition to closing your mouth and pinching your nose, you bear down as if having a bowel development. The maneuver causes several rapid developments in your heart rate and blood squeeze.

You should first try this technique under a doctor’s supervision to make sure you’re doing it correctly, and for a safe, but effective amount of time.

How-to work the maneuver To perform the Valsalva manipulation, follow these steps in order:
  1. Pinch your nose closed.
  2. Close your mouth.
  3. Try to exhale, as if inflating a blimp.
  4. Bear down, as if having a bowel movement.
  5. Do this for about 10 to 15 seconds.

The Valsalva maneuver can be done sitting or lying down. Ask your doctor which approach is right for you.

Valsalva Maneuver Preload

The previous discussion has focused on the mechanisms, both respiratory and circulatory, that occur during the Valsalva maneuver. The increase in intrathoracic pressure that occurs during the Valsalva maneuver incites a sequence of rapid changes in preload and afterload stress. During the strain, venous return to the heart is decreased and peripheral venous pressures become increased. Within the next few beats, systolic and pulse pressures begin to fall while mean arterial pressure remains near (or is elevated above) control levels owing to the transmission of airway pressure.

Thus it would appear that the benefits to cardiac contractility derived from a decrease in systolic and pulse pressure are counterbalanced by an increase in mean arterial pressure. Increases in total peripheral resistance that begin after about 7 seconds of strain produce further increases in afterload. Recruitment of autonomically mediated increases in heart rate and cardiac contractility assists the heart to maintain its cardiac output in the presence of diminished venous return. With the increased venous return that accompanies termination of Valsalva strain, there is an increase in diastolic filling and stroke volume output by means of the Frank-Starling mechanism.

Heart rate and total peripheral resistance continue to be increased during the immediate poststrain period, and the ejection of an increased stroke volume into a constricted arterial system produces a rapid and marked increase in arterial pressure–the phase IV overshoot with its subsequent slowing of heart rate.

Valsalva Maneuver Definition

The Valsalva maneuver is a technique that anybody can learn, that has several practical uses in medicine and in everyday life. The Valsalva maneuver is useful for transiently increasing the tone of the vagus nerve, and also for temporarily increasing the pressure in the throat, sinuses, and inner ears. It turns out these two effects can sometimes be quite helpful.

For instance, cardiologists often recommend the Valsalva maneuver to their patients who have episodes of certain kinds of supraventricular tachycardia (SVT), as a means of stopping the arrhythmia when it occurs. The Valsalva maneuver is also a useful technique for scuba divers, people with hiccups — and many others.

The Valsalva maneuver (which is named after A.M. Valsalva, who first described it 300 years ago as a way to expel pus out of the middle ear), is performed by attempting to exhale forcefully against a closed airway.

The Valsalva maneuver can be done by keeping your mouth closed and pinching your nose while trying to exhale forcefully. This maneuver immediately increases pressure in the sinuses and inner ears The maneuver must be maintained a little longer in order to also achieve an increase in vagal tone, at least for 10-15 seconds.1

The Valsalva maneuver greatly increases pressures inside the nasal sinuses, and especially in the chest cavity. In simple terms, the elevated chest pressure stimulates the vagus nerve and increases vagal tone. However, the Valsalva maneuver actually produces a fairly complex series of physiological events that doctors have employed over the years for several purposes.

Phases of the Valsalva Maneuver

  • From a physiological standpoint, a 15-second Valsalva maneuver has four distinct phases:
  • Phase 1: Acutely blowing against a closed airway increases the pressure inside the chest cavity, which immediately pushes blood from the pulmonary circulation into the left atrium of the heart. So, for a few seconds the amount of blood being pumped by the heart increases.
  • Phase 2: The amount of blood being pumped by the heart suddenly drops. This drop in cardiac output occurs because the increased pressure in the chest cavity prevents any more blood from returning to the chest from the rest of the body, and therefore from returning to the heart. To compensate for this drop in cardiac output, the body’s blood vessels constrict, and blood pressure rises. This elevated blood pressure continues for the duration of the Valsalva maneuver.
  • Phase 3: Occurs immediately upon resumption of normal breathing. The pressure within the chest suddenly drops, and the pulmonary circulation re-expands and fills with blood again. However, during this re-expansion of the chest (which lasts for 5-10 seconds), the cardiac output may drop further.
  • Phase 4: The blood flow to the heart and lungs returns to normal, as does the cardiac output and blood pressure.

Valsalva Maneuver Ear

Performing the valsalva maneuver tests the body’s ability to compensate for changes in the amount of blood that returns to the heart (preload). The changes in heart rate and blood pressure observed during this test are regulated by the autonomic nervous system. Patients with autonomic dysfunction will therefore have changes in heart rate and/or blood pressure that differ from those expected in healthy patients.

The test consists of blowing against resistance for several seconds, then relaxing. As soon as a person begins to blow, the sudden increase in chest and abdominal pressure forces blood out of the chest and down the arms. This increases blood pressure briefly (phase I). Soon afterwards, the amount of blood ejected by the heart with each beat (stroke volume) plummets, because the straining decreases entry of blood from the veins into the heart. Blood pressure progressively falls (phase II). The brain senses this fall and a rapid decrease in outflow in the parasympathetic nervous system to the heart. The increase in nerve traffic leads to more release of norepinephrine, which tightens blood vessels throughout the body.

When the patient relaxes at the end of the maneuver (phase III), briefly, the blood pressure falls, but then blood rushes back into the chest and within a few heartbeats, the heart ejects this blood. The blood pressure increases (phase IV) and since the blood vessels are constricted, produces an overshoot of blood pressure, outflow to blood vessels falls and in response to this increase in blood pressure the heart rate falls. The pattern of these various perturbations gives physicians important information about both sympathetic and parasympathetic function.

Can the Valsalva maneuver be dangerous?

The Valsalva maneuver can put an unhealthy strain on your heart. It can also raise your blood pressure. If you have coronary heart disease, a congenital heart defect, or other heart conditions, your doctor may advise you not to do it.

Does Valsalva maneuver decreases heart rate?


Phase 1 consists of a transient rise in arterial pressure and an associated decrease in heart rate. In phase 2, the expiratory phase of the maneuver, there is a gradual decrease in blood pressure followed by a recovery. An increase in heart rate accompanies this phase.

What does Valsalva mean?

Medical Definition of Valsalva

The Valsalva maneuver in which a person tries to exhale forcibly with a closed glottis (windpipe) so that no air goes out through the mouth or nose. 2. The renowned Italian anatomist, pathologist, physician, and surgeon Antonio Maria Valsalva (1666-1723) who first described the maneuver.