The hemodynamic effect of the Valsalva maneuver in muscular stenosis
| Autor: | John Summa, Edwin E. Westura, Frank I. Marcus |
|---|---|
| Rok vydání: | 1964 |
| Předmět: |
Cardiac Catheterization
Cardiac output medicine.medical_specialty Brachial Artery Valsalva Maneuver medicine.medical_treatment Blood Pressure Constriction Pathologic Left ventricular hypertrophy Methoxamine Internal medicine Valsalva maneuver Humans Ventricular outflow tract Medicine cardiovascular diseases Systole business.industry Respiration Angiocardiography Hemodynamics Isoproterenol Digitalis Glycosides Aortic Valve Stenosis Stroke volume medicine.disease Anesthesia Aortic valve stenosis Heart Function Tests Heart catheterization cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | American Heart Journal. 67:324-333 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/0002-8703(64)90006-7 |
| Popis: | A patient with muscular subaortic stenosis underwent hemodynamic studies on four separate occasions. At cardiac catheterization, there was a peak systolic gradient of 10 to 20 mm. Hg between the left ventricle and the brachial artery. The effective orifice size was 2 to 4 square centimeters. This gradient increased to 95 mm. Hg when isoproterenol was infused. During the strain of the Valsalva maneuver a gradient of 95 mm. Hg was induced; this regressed rapidly upon release of straining. Concomitantly, the cardiac output decreased by 61 per cent, and the stroke volume by 69 per cent of resting values. The calculated orifice size was 0.2 square centimeter. When simultaneous left ventricular and brachial arterial pressures were measured in a patient with left ventricular hypertrophy due to hypertension, and in a normotensive patient, no pressure gradient developed between the left ventricle and aorta during the Valsalva maneuver. All the drugs or maneuvers associated with an increase in left ventricular obstruction in muscular subaortic stenosis, including the Valsalva maneuver, have in common a decrease in cardiac size or in end-systolic volume. These findings lend support to the view that, with more complete left ventricular emptying, a greater opportunity is afforded for approximation of the already narrowed ventricular outflow tract, with resultant obstruction in late systole. |
| Databáze: | OpenAIRE |
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