Maniobra de Valsalva en insuficiencia cardíaca: The Valsalva maneuver is performed by inflating and locking a blood pressure cuff to 15 mm Hg above the resting supine systolic pressure (Korotkoff sounds should not be audible at this point), at which point the patient performs a sustained Valsalva (exhalation against a closed glottis) for at least 10 seconds. In a normal response, systolic blood pressure immediately rises 30 to 40 mm Hg above baseline for 1 to 3 seconds (phase 1, appearance of Korotkoff sounds). As venous return decreases, systolic blood pressure drops sharply below baseline (phase 2, disappearance of Korotkoff sounds). When the Valsalva is released, there is a further drop of systolic blood pressure below baseline (phase 3, continued absence of Korotkoff sounds). Between 3 to 15 seconds after release, systolic blood pressure rises 15 mm Hg or more above the baseline level (phase 4, reappearance of Korotkoff sounds).Two abnormal responses have been described in heart failure. In the absent overshoot response, phases 1 to 3 are normal, but Korotkoff sounds do not reappear in phase 4. In the squarewave response, phase 1 is normal, but Korotkoff sounds are present in phases 2 and 3, followed by disappearance in phase 4
Posted on: Wed, 24 Sep 2014 03:38:26 +0000
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