Open AccessThe Effect of Short‐term Isometric Muscle Contraction and the Valsalva Maneuver on Systemic and Pulmonary Hemodynamics in Patients with Severe Heart Failure
Author(s) -
Soucek Miroslav,
Frana Petr,
Kara Tomas,
Sitar Jan,
Halamek Josef,
Jurak Pavel,
Rihacek Ivan,
Spinarova Lenka,
Oral Ivo
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20390
Subject(s) - medicine , valsalva maneuver , cardiology , heart failure , hemodynamics , heart rate , blood pressure , anesthesia
Background Chronic heart failure is characterized by high mortality, frequent hospitalization, and reduced quality of life. Patients with severe heart failure are often in very poor physical condition, they are unable to take part in the usual exercise programs, and therefore need an individual approach. Hypothesis To assess the systemic and pulmonary hemodynamic responses to maximum voluntary contraction of the lower extremity muscles (MVC‐LEM) with persistent physiologic breathing, the Valsalva maneuver, and the combination of Valsalva with MVC‐LEM. Methods Seventeen patients with severe heart failure (ejection fraction 20%) were exposed to 3 types of load for a period of 10 seconds: 1) MVC‐LEM with persistent physiologic breathing, 2) the Valsalva maneuver, and 3) a combination of MVC‐LEM with the Valsalva maneuver. During each measurement, a continuous, time‐synchronized record was taken of the electrocardiogram, and the pulmonary and systemic blood pressures. Results There were slight changes in the heart rate and systemic blood pressure when comparing resting versus MVC‐LEM values. There were much greater and significant changes ( P < .01) in the systemic and pulmonary blood pressures when comparing resting versus the Valsalva maneuver or the combination of the MVC‐LEM plus the Valsalva maneuver values. Conclusions A short maximum voluntary contraction of the muscles of the lower extremities with persistent physiologic breathing did not have an abnormal effect on the systemic and pulmonary hemodynamics in patients with severe chronic heart failure. The Valsalva maneuver caused significantly higher hemodynamic changes in the systemic and pulmonary system with possible negative effects. Copyright © 2009 Wiley Periodicals, Inc.