Sample and receive Valsalva - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | In The Cardiology

Despite the fact that in humans there are regulating mechanisms that support the right heart rate, sometimes due to diseases of the heart or other organs develop arrhythmias, including tachycardia - increased heart rate.Heart palpitations may be physiological, eg, as a result of an adequate response to physical activity, 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, specifically, the risk of sudden cardiac death.To do this, doctors have developed a whole system of classifications, grades and scales of risk factors, but this article will be more fully described on a sample and reception of Valsalva.Last besides in some types of tachycardia has a therapeutic effect, allowing you to quickly eliminate the unpleasant symptoms of frequent palpitations.

First, let's distinguish between the concept of "sample" and "receiving" Valsalva.Valsalva maneuver - a diagnostic measures used by cardiologists,

vascular surgeons, ENT - doctors for the diagnosis of relevant diseases.Admission Valsalva - a patient's actions, which are aimed at creating a high pressure in the middle ear cavity, the chest and abdominal cavities.These actions are in a deep breath, followed by a deep breath, and straining to breath-hold for 15 - 20 seconds.That is, holding a Valsalva maneuver is based on the implementation of the eponymous reception.Acceptance was proposed by Italian scientists in the 18th - century and was used for cleaning the cavity of the middle ear of pus resulting from perforation of the tympanic membrane under the influence of the charge air in the throat.In the mid-20 th century, it was used in obstetrics during attempts (the expulsion of the fetal period).

What is the basis Valsalva maneuver?

Action method is based on the change of pressure in the chest and abdominal cavities of the patient while straining.As a result of changes hemodynamics (blood flow through the vessels).All processes can be divided into four phases.The first two phases correspond to periods of tension, the last two - a period of relaxation after straining.First, there is a mechanical spadenie large veins, because of which decreases blood flow to the heart.This causes a decrease in cardiac output, blood pressure and a reflex increase in heart rate.At the beginning of relaxation of the patient blood flow to the heart is reduced and increased, increased blood ejection into the aorta and increased blood pressure.Here are connected baroreceptors located in the carotid sinus (portion of the carotid artery), catching high blood pressure and send signals to the brain through the nerves of the carotid artery.In the brain, signals are transmitted to the nucleus of the vagus nerve, which branches, affecting the heart, leading to slow its rate cuts.This sequence of reactions is carried out in a healthy heart and blood vessels.

If the heart has a pathological process such as changes after myocardial infarction, the heart muscle is not able to change the rhythm of their cuts in response to stimulation of the vagus nerve.Such a heart is probably already worn out and more likely to develop asystole (stop), and as a result, the onset of clinical death.

Additionally, straining causes an increase in pressure in the veins of the lower extremities.In the case of insolvency of venous valves femur and tibia blood moves in the opposite direction (retrograde blood flow), which normally should not be.In otorhinolaryngology

straining during deep exhalation has another effect - is an increase in pressure in a closed nasopharynx, which leads to the opening of the auditory (Eustachian) tubes and increase the pressure in the middle ear cavity.This is in the case of accumulation of pus in the middle ear can cause breakthrough (perforation) of the tympanic membrane with the release of purulent masses outside.

Indications for Valsalva

sample may be used for the following diseases:
- diagnostics types of tachycardia, together with ECG recordings
- assessment of the risk of death after myocardial infarction depending on the variability of the level of heart rate caused by the vagal influence on the heart (the influence of the vagus nerve)
- assessment of valvular function of the lower extremities in conjunction with Doppler examination
- assessment of patency of the auditory tubes.

Reception Valsalva is used in situations such as:
- an independent symptom relief palpitations.Perhaps in the event that a patient diagnosed with sinus tachycardia or supraventricular (atrial or nodal).It is used as an alternative vagal samples, which educates the patient by the doctor.
- elimination of unpleasant sensations in the middle ear when submerged under water divers
- the elimination of differential pressure in the middle ear, the passengers of the aircraft during climb and landing.

Contraindications for sample

Self can not use this method if 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.

doctor will carry out a study, if the patient has such disease:

- acute heart attack or stroke
- thromboembolism arteries (pulmonary, mesenteric, femoral)
- acute surgical diseases (appendicitis, peritonitis)
- acute thrombosis of the lower extremities
- proliferative retinopathy (an eye disease of the retina)
- fever, sepsis, acute infectious disease
- exacerbation of any chronic disease

Technique / receive samples Valsalva maneuver

in cardiology test is conducted under the supervision of a physician in the supine or sitting with simultaneous recording of ECG andHELL.The patient is asked to inhale deeply, then slowly exhale deeply into the mouthpiece with a narrow opening for 15 - 20 seconds.Then you can relax and catch your breath.Further, the ECG analysis is conducted.
in vascular surgery trial conducted before and after ultrasound vessels and legs.The patient is asked to stand up, breathe and try to exhale with your mouth closed.That is the very breath is not carried out, instead of it happening straining and tension of the thoracic and abdominal muscles.Immediately carry out Doppler - a study of the lower extremities to assess blood flow in the veins.

Valsalva Reception follows the same pattern - inhaling and exhaling attempt to straining.Passengers are recommended to inhale the aircraft, close the mouth and nose with his hand and mouth to breathe not, and trying to push air into your ears.

Evaluation

In assessing the risk of sudden cardiac death in patients with organic heart lesions result is interpreted as follows.On ECG calculated the longest and the shortest interval between two ventricular contractions (R interval - R).The ratio of long to short must be more than 1.7.The indicator is called the Valsalva ratio.Ratio in the range 1.3 - 1.7 is considered to be the boundary value and significantly below 1.3 indicates a high risk of cardiac death.This is due to insufficient reflex reaction of the heart to the influence of the vagus nerve.

In assessing the patency of venous shins calculated figures obtained by ultrasound with Doppler.If retrograde blood flow rate of more than 30 cm / s and a duration of more than 1 second, it indicates the inability of the veins to keep blood in them at higher pressure.In this case, the sample is considered positive.

therapists Sazykina OJ