From the Guidelines
The Valsalva maneuver typically decreases the intensity of pulmonic regurgitation (PR) murmurs. During Valsalva, increased intrathoracic pressure reduces venous return to the right heart, decreasing right ventricular volume and pulmonary artery pressure. This reduction in pressure gradient between the pulmonary artery and right ventricle during diastole leads to a softer PR murmur. PR murmurs are diastolic, decrescendo, blowing murmurs best heard at the left upper sternal border. They can be difficult to distinguish from aortic regurgitation murmurs, making the Valsalva maneuver a useful diagnostic tool. While aortic regurgitation murmurs also decrease with Valsalva, PR murmurs may show a more pronounced reduction due to the right heart's greater sensitivity to preload changes.
Some key points to consider when evaluating PR murmurs include:
- The response of the murmur to various physiological maneuvers, such as respiration and Valsalva, can provide valuable diagnostic information 1.
- Echocardiography is an important tool in the evaluation of heart murmurs, and can help to define the primary lesion, hemodynamics, and coexisting abnormalities 2, 3.
- The intensity of the murmur can increase during inspiration, and decrease during expiration, which can help to distinguish PR murmurs from other types of murmurs 1, 4.
- The Valsalva maneuver can be used in combination with other maneuvers, such as respiration assessment, to provide more comprehensive diagnostic information 1, 5.
Overall, the Valsalva maneuver is a useful diagnostic tool in the evaluation of PR murmurs, and can help to distinguish them from other types of murmurs. By combining the Valsalva maneuver with other physiological maneuvers and echocardiography, clinicians can gain a better understanding of the underlying cardiac lesion and develop an effective treatment plan.
From the Research
Effect of Valsalva Maneuver on Pulmonic Regurgitation Murmur
- The Valsalva maneuver has various hemodynamic effects that can be used to aid in the diagnosis of cardiac conditions, including the assessment of murmurs 6.
- However, the specific effect of the Valsalva maneuver on the murmur of pulmonic regurgitation is not directly addressed in the provided studies.
- The Valsalva maneuver can decrease preload and increase right atrial pressure, which may affect the intensity of certain murmurs 6, 7.
- Respiratory variations, including the Valsalva maneuver, can change right ventricular preload and afterload, potentially influencing the ejection fraction and the presence of tricuspid regurgitation 8.
- The Valsalva maneuver can also increase peak systolic and diastolic pressure, although the effect may vary among individuals 9.
- While the studies discuss the effects of the Valsalva maneuver on various cardiac parameters, they do not provide specific information on its effect on the murmur of pulmonic regurgitation 10.