Valsalva Manoeuvre: A Patient’s Guide

Valsalva Manoeuvre: Safe Breathing Technique for Everyday Use

Valsalva’s manoeuvre is a breathing technique that involves forcefully exhaling against a closed airway. This method is often used to help unclog ears, restore a normal heart rhythm, or diagnose issues with the autonomic nervous system.

How to Perform Valsalva’s Manoeuvre?

It is a quick and non-invasive method for a fast heart rhythm, known as supraventricular tachycardia. These are the steps to perform Valsalva’s manoeuvre at home:

• Step 1: Sit or lie down in a comfortable position.
• Step 2: Take a moderate breath.
• Step 3: Close your mouth and pinch your nose shut to seal the airway.
• Step 4: Gently try to exhale against this closed airway for about 10-15 seconds, as if straining (but avoid excessive force).

Maintain precautions when performing this technique to clean or unclog your ears. If you perform it too forcefully, it can rupture your eardrum.

Why Do We Need to Perform Valsalva’s Manoeuvre?

It is a common breathing technique performed by many people worldwide. This technique does not require any equipment and can be done anywhere. Let us highlight some applications of this procedure:

Assessing the Autonomic Nervous System

The manoeuvre can help you identify problems with sympathetic and parasympathetic nerves, which regulate functions like blood pressure and heart rate. It can also assess autonomic dysfunction as a marker for heart failure.

Terminating Supraventricular Tachycardia (SVT)

It can terminate supraventricular tachycardia (SVT) by increasing vagal tone and slowing the heart rate. The Valsalva manoeuvre triggers the Bezold-Jarisch reflex, leading to bradycardia and hypotension, ultimately interrupting the normal heart rhythm.

Evaluating Cardiac Conditions

The Valsalva manoeuvre causes a predictable series of changes in heart rate and blood pressure. These changes in heart rate and blood pressure can help assess autonomic function and identify potential issues with cardiac performance.

What are the Types of Valsalva's Manoeuvre?

There are several variations of Valsalva’s manoeuvre, including the standard Valsalva manoeuvre, modified Valsalva manoeuvre, and reverse Valsalva manoeuvre. These variations differ in how they are performed and the effects they have on your body.

Let us discuss the variations of Valsalva’s manoeuvre in detail:

Standard Valsalva Manoeuvre

Here we will discuss how to perform and the effects of this technique:

1. How to Perform: Take a deep breath, close your mouth and nose, then forcefully exhale as if trying to blow into a closed straw.
2. Effects: This manoeuvre causes temporary changes in blood pressure and heart rate, as well as other physiological responses.

Modified Valsalva Manoeuvre

Let us understand how to perform this manoeuvre and its effect on your body:

How to Perform:

1. Lie on a bed at a 45-degree angle (semi-recumbent).
2. Perform the standard Valsalva strain (exhaling against a closed airway for 15 seconds).
3. Immediately after the strain, a helper rapidly lowers you to a flat lying position and raises your legs to a 45-degree angle for 15 seconds.
4. After this, you return to the semi-recumbent position. 

Effects: Healthcare providers sometimes recommend this to treat supraventricular tachycardia, as it may be more effective than the standard Valsalva manoeuvre.

What are the Physiological Effects of Performing Valsalva's Manoeuvre?

The Valsalva manoeuvre has various physiological effects, as it produces a series of haemodynamic changes. These changes increase and decrease your heart rate and can cause different physiological effects, which we will discuss here:

Haemodynamic Change

Here are some physiological effects that occur during the initial phase of the Valsalva manoeuvre:

1. Increased Intrathoracic Pressure: Closing your glottis forces expiration, causing intrathoracic pressure to rise significantly.
2. Reduced Venous Return: This increased pressure compresses the thoracic blood vessels and cardiac chambers, reducing venous return to your heart.
3. Decreased Cardiac Output: As less blood returns to the heart, the amount of blood pumped with each beat decreases.

Compensatory Mechanism

These are some compensatory mechanisms that cause some physiological effects in your body:

1. Baroreceptor Reflex: The decreased blood pressure activates baroreceptors in the carotid arteries and aortic arch, which initiate a reflex to increase blood pressure.
2. Autonomic Nervous System: The autonomic nervous system plays a crucial role in regulating heart rate and blood vessel tone in response to changes in intrathoracic pressure and blood pressure.
3. Vasoconstriction: The sympathetic nervous system may cause vasoconstriction in an attempt to raise blood pressure.

The Valsalva manoeuvre can lead to adverse effects such as syncope, chest pain, or arrhythmias. These can be potential risks for those who are suffering from underlying cardiovascular or cerebrovascular conditions.