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Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver

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Abstract

Measurement of beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver is the basis for a highly informative autonomic function test. Whereas in the past this measurement required intra-arterial cannulation, the development of finger cuff devices that acquire arterial pressure waveforms indistinguishable from those recorded intra-arterially has made it possible to obtain accurate measurements noninvasively. In a patient with orthostatic hypotension, the pattern of blood pressure responses during and after the release of the maneuver can identify a neurogenic basis: sympathetic neurocirculatory failure. The quantifiable change in cardiac interbeat interval per unit change in systolic pressure during the maneuver can identify baroreflex-cardiovagal failure.

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Abbreviations

AAG:

Autoimmune autonomic ganglionopathy

ANS:

Autonomic nervous system

COI:

Chronic orthostatic intolerance

NE:

Norepinephrine

MSA:

Multiple system atrophy

OH:

Orthostatic hypotension

OI:

Orthostatic intolerance

PAF:

Pure autonomic failure

PNS:

Parasympathetic nervous system

POTS:

Postural tachycardia syndrome

SAS:

Sympathetic adrenergic system

SCS:

Sympathetic cholinergic system

SEC:

Skin electrical conductance

SNS:

Sympathetic noradrenergic system

References

  1. Appenzeller O, Descarries L (1964) Circulatory reflexes in patients with cerebrovascular disease. N Engl J Med 271:820–823

    Article  CAS  PubMed  Google Scholar 

  2. Appenzeller O, Goss JE (1971) Autonomic deficits in Parkinson’s syndrome. Arch Neurol 24:50–57

    Article  CAS  PubMed  Google Scholar 

  3. Appenzeller O, Kornfeld M (1973) Acute pandysautonomia. Clinical and morphologic study. Arch Neurol 29:334–339

    Article  CAS  PubMed  Google Scholar 

  4. Bristow JD, Honour J, Pickering GW, Sleight P, Smyth HS (1969) Diminished baroreflex sensitivity in high blood pressure. Circulation 39:48–54

    Article  CAS  PubMed  Google Scholar 

  5. Delius W, Hagbarth KE, Hongell A, Wallin BG (1972) Manoeuvres affecting sympathetic outflow in human muscle nerves. Acta Physiol Scand 84:82–94

    Article  CAS  PubMed  Google Scholar 

  6. Derbes VJ, Kerr A Jr (1955) Valsalva’s maneuver and Weber’s experiment. N Engl J Med 253:822–823

    Article  CAS  PubMed  Google Scholar 

  7. Eckberg DL, Abboud FM, Mark AL (1976) Modulation of carotid baroreflex responsiveness in man: effects of posture and propranolol. J Appl Physiol 41:383–387

    CAS  PubMed  Google Scholar 

  8. Elisberg EI (1963) Heart rate response to the Valsalva maneuver as a test of circulatory integrity. JAMA 186:200–205

    Article  CAS  PubMed  Google Scholar 

  9. Frank SM, Satitpunwaycha P, Bruce SR, Herscovitch P, Goldstein DS (2003) Increased myocardial perfusion and sympathoadrenal activation during mild core hypothermia in awake humans. Clin Sci 104:503–508

    Article  PubMed  Google Scholar 

  10. Goldstein DS, Frank SM (2001) The wisdom of the body revisited: the adrenomedullary response to mild core hypothermia in humans. Endocr Regul. 35:3–7

    CAS  PubMed  Google Scholar 

  11. Goldstein DS, Horwitz D, Keiser HR (1982) Comparison of techniques for measuring baroreflex sensitivity in man. Circulation 66:432–439

    Article  CAS  PubMed  Google Scholar 

  12. Goldstein DS, Keiser HR (1984) Pressor and depressor responses after cholinergic blockade in humans. Am Heart J 107:974–979

    Article  CAS  PubMed  Google Scholar 

  13. Goldstein DS, Tack C (2000) Non-invasive detection of sympathetic neurocirculatory failure. Clin Auton Res 10:285–291

    Article  CAS  PubMed  Google Scholar 

  14. Hamilton WF, Woodbury RA, Harper HT Jr (1936) Physiologic relationships between intrathoracic, intraspinal and arterial pressures. JAMA 107:853–856

    Article  Google Scholar 

  15. Henderson LA, Macey PM, Macey KE, Frysinger RC, Woo MA, Harper RK, Alger JR, Yan-Go FL, Harper RM (2002) Brain responses associated with the Valsalva maneuver revealed by functional magnetic resonance imaging. J Neurophysiol 88:3477–3486

    Article  PubMed  Google Scholar 

  16. Houtman S, Oeseburg B, Hopman MT (1999) Non-invasive assessment of autonomic nervous system integrity in able-bodied and spinal cord-injured individuals. Clin Auton Res 9:115–122

    Article  CAS  PubMed  Google Scholar 

  17. Imholz BP, van Montfrans GA, Settels JJ, van der Hoeven GM, Karemaker JM, Wieling W (1988) Continuous non-invasive blood pressure monitoring: reliability of Finapres device during the Valsalva manoeuvre. Cardiovasc Res 22:390–397

    Article  CAS  PubMed  Google Scholar 

  18. Jellinek EH (2006) The Valsalva manoeuvre and Antonio Valsalva (1666–1723). J R Soc Med 99:448–451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Looga R (2005) The Valsalva manoeuvre—cardiovascular effects and performance technique: a critical review. Respir Physiol Neurobiol 147:39–49

    Article  PubMed  Google Scholar 

  20. Matsukawa T, Sugiyama Y, Watanabe T, Kobayashi F, Mano T (1998) Baroreflex control of muscle sympathetic nerve activity is attenuated in the elderly. J Auton Nerv Syst 73:182–185

    Article  CAS  PubMed  Google Scholar 

  21. McKendrick JG (1910) Hearing. In: Chisholm H (ed) The encyclopaedia Britannica. The Encyclopaedia Britannica Company, New York, p 123a

  22. Monahan KD, Dinenno FA, Seals DR, Clevenger CM, Desouza CA, Tanaka H (2001) Age-associated changes in cardiovagal baroreflex sensitivity are related to central arterial compliance. Am J Physiol 281:H284–H289

    CAS  Google Scholar 

  23. Novak P (2011) Assessment of sympathetic index from the Valsalva maneuver. Neurology 76:2010–2016

    Article  PubMed  PubMed Central  Google Scholar 

  24. O’Neill A, Cudkowicz L (1965) Effect of L-norepinephrine on right atrial pressure and the “square wave response” to the Valsalva maneuver. Am Heart J 69:220–228

  25. Pickering TG, Sleight P (1969) Quantitative index of baroreflex activity in normal and hypertensive subjects using Valsalva’s manoeuvre. Br Heart J 31:392

    CAS  PubMed  Google Scholar 

  26. Rahman F, Goldstein DS (2014) Quantitative indices of baroreflex-sympathoneural function. Clin Auton Res 24:103–110

    Article  PubMed  Google Scholar 

  27. Robertson D, Haile V, Perry SE, Robertson RM, Phillips JA 3rd, Biaggioni I (1991) Dopamine beta-hydroxylase deficiency. A genetic disorder of cardiovascular regulation. Hypertension 18:1–8

    Article  CAS  PubMed  Google Scholar 

  28. Sandroni P, Benarroch EE, Low PA (1991) Pharmacological dissection of components of the Valsalva maneuver in adrenergic failure. J Appl Physiol (1985) 71:1563–1567

    CAS  Google Scholar 

  29. Schrezenmaier C, Singer W, Swift NM, Sletten D, Tanabe J, Low PA (2007) Adrenergic and vagal baroreflex sensitivity in autonomic failure. Arch Neurol 64:381–386

    Article  PubMed  Google Scholar 

  30. Sharpey-Schafer EP (1955) Effects of Valsalva’s manoeuvre on the normal and failing circulation. Br Med J 1:693–695

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Shimada K, Kitazumi T, Ogura H, Sadakane N, Ozawa T (1986) Effects of age and blood pressure on the cardiovascular responses to the Valsalva maneuver. J Am Geriatr Soc 34:431–434

    Article  CAS  PubMed  Google Scholar 

  32. Shoemaker JK, Hogeman CS, Sinoway LI (2003) Sympathetic responses to Valsalva’s manoeuvre following bed rest. Can J Appl Physiol 28:342–355

    Article  PubMed  Google Scholar 

  33. Smyth HS, Sleight P, Pickering GW (1969) Reflex regulation of arterial pressure during sleep in man: quantitative method of assessing baroreflex sensitivity. Circ Res 24:109–121

    Article  CAS  PubMed  Google Scholar 

  34. Vaisrub S (1974) Editorial: the Valsalva maneuver in diabetic neuropathy. JAMA 228:1151

    Article  CAS  PubMed  Google Scholar 

  35. Vogel ER, Corfits JL, Sandroni P, Sletten DM, Benarroch EE, Fealey RD, Suarez GA, Gehrking TL, Gehrking JA, Low PA (2008) Effect of position on valsalva maneuver: supine versus 20 degree position. J Clin Neurophysiol 25:313–316

    Article  PubMed  PubMed Central  Google Scholar 

  36. Vogel ER, Sandroni P, Low PA (2005) Blood pressure recovery from Valsalva maneuver in patients with autonomic failure. Neurology 65:1533–1537

    Article  PubMed  Google Scholar 

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Correspondence to David S. Goldstein.

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The research reported here was supported by the Division of Intramural Research, NINDS, NIH (grant no. 1ZIANS003034).

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Goldstein, D.S., Cheshire, W.P. Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver. Clin Auton Res 27, 361–367 (2017). https://doi.org/10.1007/s10286-017-0474-y

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  • DOI: https://doi.org/10.1007/s10286-017-0474-y

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