Trial and reception Valsalva - Causes, symptoms and treatment. MF.

Despite the fact that in the human body there are mechanisms of regulation that support the correct rhythm of heartbeats, sometimes due to heart disease or other organs develop rhythm disturbances, including tachycardia - an increase in heart rate. A heart palpitations can be physiological, for example, as a result of an adequate response to physical exertion, and pathological, caused by serious diseases of the heart muscle. In the latter case, it is important to assess the type of tachycardia and its prognostic value, in particular, the risk of sudden cardiac death. For this purpose, the doctors have developed whole systems of classifications, gradations and scales of risk factors, but this article will describe in more detail the trial and reception of Valsalva. Last, moreover, with some types of tachycardia has a curative effect, allowing you to quickly eliminate the unpleasant symptoms of frequent heartbeats.

To begin with it is necessary to distinguish between the concept of "sample" and "reception" of Valsalva. The Valsalva trial is a diagnostic measure used by cardiologists, vascular surgeons, ENTs - physicians for the diagnosis of diseases of the relevant organs. Admission Valsalva - is the patient's actions, which are aimed at creating high pressure in the cavity of the middle ear, thoracic and abdominal cavities. These actions consist in a deep breath, followed by a deep exhalation, with straining and respiratory depression for 15-20 seconds. That is, carrying out the Valsalva trial is based on the same reception. The reception was offered to the Italian scientist in the 18th century and was used to purify the middle ear cavity from pus as a result of the perforation of the tympanic membrane under the influence of pumping air in the pharynx. In the middle of the 20th century it was used in obstetrics in the period of attempts( the period of the fetal expulsion).What is the basis of the Valsalva trial?

The effect of the method is based on a change in the pressure in the thoracic and abdominal cavities when the patient is straining. As a result, changes in hemodynamics( blood flow through the vessels).All processes can be divided into 4 phases. The first two phases correspond to the period of tension, the last two - the period of relaxation after straining. First, there is a mechanical collapse of large veins, because of which the flow of blood to the heart decreases. This causes a decrease in cardiac output, blood pressure and a reflex increase in heart rate. At the beginning of the patient's relaxation, the influx of blood to the heart is restored and increased, the discharge of blood into the aorta and the increase in blood pressure increase. Here, the baroreceptors located in the carotid sinus( carotid artery region) are connected, catching high blood pressure and sending signals to the brain along the nerves from the carotid artery. In the brain, signals are transmitted to the nuclei of the vagus nerve, the branches of which, acting on the heart, lead to a slowing of the frequency of its contractions. This sequence of reactions is carried out in a healthy heart and vessels.

If in the heart there is a pathological process, for example, changes after myocardial infarction, the cardiac muscle is not able to change the rhythm of its contractions in response to the stimulation of the vagus nerve. Such a heart is probably already worn out and more at risk of developing asystole( stopping), and, as a consequence, the onset of clinical death.

In addition, straining causes an increase in pressure in the veins of the lower extremities. In the case of the failure of the valves of the veins of the hip and shin, the blood moves in the opposite direction( retrograde blood flow), which should normally not occur.

In otorhinolaryngology, straining with a deep expiration has a different effect - there is an increase in pressure in the closed nasopharynx, which leads to the opening of auditory( Eustachian) tubes and increased pressure in the middle ear cavity. This in case of accumulation of pus in the middle ear can cause a perforation of the tympanic membrane with the release of purulent masses outwards.

Indications for Walsalva

test The sample can be used for the following diseases:
- diagnosis of tachycardia together with ECG
recording - assessment of mortality risk after myocardial infarction, depending on the level of heart rate variability caused by vagal effect on the heart( vagus nerve effect)
- assessment of the valvular apparatus function of the veins of the lower extremities together with the dopplerographic study
- evaluation of the permeability of the auditory tubes.

Valsalva is used in situations such as:
- self-relieving symptoms of rapid heart rate. Perhaps in the event that the patient is diagnosed with sinus or supraventricular tachycardia( atrial or nodular).It is used as a variant of vagal samples, which the patient is taught by a doctor.
- elimination of unpleasant sensations in the middle ear when immersing divers under the water
- elimination of pressure drops in the middle ear of passengers of the aircraft when climbing and landing.

Contraindications for sampling

Independently it is impossible to use this method for tachycardia accompanied by pain in the heart, loss of consciousness, suffocation, a sharp decrease in blood pressure. In this case, you need to call an ambulance.

The doctor will not perform the examination if the patient has such a disease:

- acute infarction or stroke
- thromboembolism of the arteries( pulmonary, mesenteric, femoral)
- acute surgical diseases( appendicitis, peritonitis)
- acute thrombosis of the lower extremity veins
-proliferative retinopathy( retinal disease)
- fever, sepsis, acute infectious disease
- exacerbation of any chronic disease

Valsava technique

In cardiology, the test is performedwith the doctor in a supine or sitting position with simultaneous registration of the ECG and blood pressure. The patient is asked to take a deep breath, then gently exhale deeply into the mouthpiece with a narrow hole for 15 to 20 seconds. Then you can relax and regain your breath. Then the cardiogram is analyzed.
In vascular surgery, the sample is performed before and after ultrasound examination of vessels and shins. The patient is asked to stand up, inhale and try to exhale with a closed mouth. That is, the exhalation itself is not carried out, instead of it there is straining and tension of the thoracic and abdominal muscles. Immediately carry out Doppler - study of the vessels of the lower limbs to assess the flow of blood in the veins.

The reception of Valsalva is carried out in a similar way - a breath and an exhalation attempt with straining. Passengers of the airplane are advised to inhale, close the nose and mouth with the palm of their hand and exhale not with the mouth, but trying to push the air into the ears.

Evaluation of results

In assessing the risk of sudden cardiac death in individuals with organic heart disease, the result is interpreted as follows. On the cardiogram, the longest and shortest interval between two contractions of the ventricles( R-R interval) is calculated. The ratio of long to short should be more than 1.7.The index is called the Valsalva coefficient. Coefficient in the range 1.3 - 1.7 is considered a boundary value, and below 1.3 it is reliable evidence of a high risk of cardiac death. This is due to an inadequate reflex response of the heart to the effect of the vagus nerve.

When assessing the permeability of the veins of the shins, the values ​​obtained as a result of ultrasound with a doppler are calculated. If the retrograde velocity of blood flow is more than 30 cm / s and lasting more than 1 sec, this indicates the inability of the veins to retain blood as the pressure in them increases. In this case, the sample is considered positive.

Doctor therapist Sazykina O.Yu.