Young investigators' award
A simple test of cardiac function based upon the heart rate changes induced by the valsalva maneuver

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Abstract

The Valsalva ratio (the ratio of the maximal tachycardia to the maximal bradycardia induced by a standard Valsalva maneuver) was determined in 200 normal subjects and 220 patients with heart disease and related disorders. Ninety-six percent of the normal subjects had Valsalva ratios of 1.50 or higher, and this value was defined as the lower limit of normal.

The Valsalva ratio tended to decrease with increasing severity of dyspnea in patients with aortic and mitral valve disease, ischemic heart disease and cardiomyopathies.

The Valsalva ratio was inversely related to the left ventricular end-diastolic pressure (p < 0.01) and the mean pulmonary wedge pressure (p < 0.01) in patients with aortic valve disease and mitral insufficiency.

There was a statistically significant tendency (p < 0.01) for patients with radiologic evidence of pulmonary congestion to have abnormally low Valsalva ratios, and for patients without pulmonary congestion to have normal values.

Abnormal Valsalva ratios were recorded in patients with right ventricular failure secondary to thromboembolic pulmonary hypertension and chronic pulmonary disease.

Among patients with left to right shunts, the Valsalva ratio was a hyperbolic function (p < 0.001) of the pulmonary to systemic flow ratio, the left to right shunt flow and the total pulmonary flow.

Measurement of the changes in heart rate induced by the Valsalva maneuver provides a rapid, safe and inexpensive method of evaluating cardiac function, and permits the prediction of certain hemodynamic variables without subjecting patients to cardiac catheterization.

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    This work was completed during the tenure of Postdoctoral Research Fellowship 1-F2-HE-22, 530-01, National Heart Institute, U.S. Public Health Service.

    Present address: Department of Medicine, Beth Israel Hospital, Boston, Mass. Winner of third place in the Young Investigators' Awards competition on February 5, 1966, at the Annual Meeting of the American College of Cardiology in Chicago.

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