From the Guidelines
The Valsalva maneuver decreases the intensity of aortic regurgitation murmurs. During the strain phase of Valsalva, there is reduced venous return to the heart, which leads to decreased left ventricular volume and cardiac output. This reduction in cardiac output results in a lower pressure gradient between the aorta and left ventricle during diastole, thereby diminishing the intensity of the aortic regurgitation murmur. The murmur of aortic regurgitation is typically a high-pitched, blowing, decrescendo diastolic murmur best heard at the left sternal border with the patient leaning forward and in deep exhalation. This auscultatory finding is important for clinicians to recognize when evaluating patients with suspected valvular heart disease. After the Valsalva maneuver is released, the murmur intensity returns to baseline as hemodynamics normalize. This response to Valsalva helps differentiate aortic regurgitation from other murmurs like mitral stenosis, which typically increases in intensity during the strain phase of Valsalva. Some key points to consider when evaluating the effect of the Valsalva maneuver on aortic regurgitation murmurs include:
- The mechanism by which the Valsalva maneuver affects cardiac output and pressure gradients 1
- The characteristic auscultatory findings of aortic regurgitation, including the high-pitched, blowing, decrescendo diastolic murmur 1
- The differentiation of aortic regurgitation from other murmurs, such as mitral stenosis, based on response to Valsalva 1
- The importance of considering multiple factors, including respiration, exercise, and positional changes, when evaluating cardiac murmurs 1
From the Research
Effect of Valsalva Maneuver on Aortic Regurgitation Murmur
- The provided studies do not directly address the effect of the Valsalva maneuver on the murmur of Aortic Regurgitation.
- However, the Valsalva maneuver's general effects on cardiac function and murmurs are discussed in several studies 2, 3, 4, 5.
- One study mentions that no single maneuver, including the Valsalva maneuver, can identify the murmur of aortic stenosis, but the diagnosis can be made by exclusion 2.
- Another study discusses the mechanisms and clinical implications of the Valsalva maneuver, including its effects on intrathoracic pressure, preload, and afterload stress 3.
- A study on the pulse pressure response to the Valsalva maneuver in humans with preserved systolic function found that the aortic pulse amplitude ratio during the strain phase relates to baseline total arterial compliance and right heart filling pressures, but not to left ventricular function 5.
- There is no direct evidence on the effect of the Valsalva maneuver on the murmur of Aortic Regurgitation, and more research would be needed to determine this effect.