Effect of position on valsalva maneuver

Supine versus 20 degree position

Elizabeth R. Vogel, Jeanne L. Corfits, Paola Sandroni, David M. Sletten, Eduardo E. Benarroch, Robert D. Fealey, Guillermo A. Suarez, Tonette L. Gehrking, Jade A. Gehrking, Phillip Anson Low

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Blood pressure changes in response to the Valsalva maneuver (VM), which reflect the integrity of the baroreflex that regulates blood pressure. Performing this maneuver in the standard supine position often prevents adequate venous preload reduction, resulting in a rise rather than a fall in blood pressure, the "flat-top" Valsalva response. We determined whether performing the VM at a 20 degree angle of head-up tilt (20°) improves preload reduction, thereby reducing the frequency of flat-top responses, improving reflex vasoconstriction, and increasing the Valsalva ratio. One hundred thirty patients were evaluated in a prospective study. Each patient performed the VM in both supine and 20°positions.Flat-top responses were present in 18% of subjects when supine. Twenty degree angle of head-up tilt position reduced the flat-top response by 87%. The components of the response that are dependent on preload reduction (Valsalva ratio and phases II-E, II-L, and IV) also showed significant improvement with 20°.A 20 degree angle of tilt is sufficient to reduce venous preload, decreasing flat-top response rate and improving the Valsalva ratio and the morphology of the VM. We recommend this modification for laboratory evaluation of the VM, whenever a flat-top response is seen.

Original languageEnglish (US)
Pages (from-to)313-316
Number of pages4
JournalJournal of Clinical Neurophysiology
Volume25
Issue number5
DOIs
StatePublished - Oct 2008

Fingerprint

Valsalva Maneuver
Blood Pressure
Head
Baroreflex
Supine Position
Vasoconstriction
Reflex
Prospective Studies

Keywords

  • Adrenergic
  • Baroreflex
  • Valsalva maneuver

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology
  • Physiology (medical)
  • Medicine(all)

Cite this

Vogel, E. R., Corfits, J. L., Sandroni, P., Sletten, D. M., Benarroch, E. E., Fealey, R. D., ... Low, P. A. (2008). Effect of position on valsalva maneuver: Supine versus 20 degree position. Journal of Clinical Neurophysiology, 25(5), 313-316. https://doi.org/10.1097/WNP.0b013e318182d319

Effect of position on valsalva maneuver : Supine versus 20 degree position. / Vogel, Elizabeth R.; Corfits, Jeanne L.; Sandroni, Paola; Sletten, David M.; Benarroch, Eduardo E.; Fealey, Robert D.; Suarez, Guillermo A.; Gehrking, Tonette L.; Gehrking, Jade A.; Low, Phillip Anson.

In: Journal of Clinical Neurophysiology, Vol. 25, No. 5, 10.2008, p. 313-316.

Research output: Contribution to journalArticle

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', Journal of Clinical Neurophysiology, vol. 25, no. 5, pp. 313-316. https://doi.org/10.1097/WNP.0b013e318182d319
Vogel ER, Corfits JL, Sandroni P, Sletten DM, Benarroch EE, Fealey RD et al. Effect of position on valsalva maneuver: Supine versus 20 degree position. Journal of Clinical Neurophysiology. 2008 Oct;25(5):313-316. https://doi.org/10.1097/WNP.0b013e318182d319
Vogel, Elizabeth R. ; Corfits, Jeanne L. ; Sandroni, Paola ; Sletten, David M. ; Benarroch, Eduardo E. ; Fealey, Robert D. ; Suarez, Guillermo A. ; Gehrking, Tonette L. ; Gehrking, Jade A. ; Low, Phillip Anson. / Effect of position on valsalva maneuver : Supine versus 20 degree position. In: Journal of Clinical Neurophysiology. 2008 ; Vol. 25, No. 5. pp. 313-316.
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