Valsalva Maneuver: Uses, How to Perform & Phases

The Valsalva maneuver is a technique that involves forcefully exhaling against a closed airway, typically by holding the breath while pinching the nose and closing the mouth. Originally described in 1704, it continues to be widely used in clinical settings due to its predictable cardiovascular and neurological effects.

As pressure builds in the chest during the maneuver, it triggers four distinct hemodynamic phases that affect heart rate and blood pressure. These changes allow healthcare providers to test autonomic function, detect heart failure, and restore normal heart rhythm during certain arrhythmias.

In addition to its use in medicine, the Valsalva maneuver is commonly applied in ear pressure equalization and sports training. When performed correctly, it is considered safe for most people and remains an important, low-cost tool for bedside assessment.

What it is used for

The Valsalva maneuver may be used to:

• Slow the heart rate and treat supraventricular tachycardia, which is a type of abnormal heart rhythm

• Evaluate for heart failure

• Detect heart murmurs

• Reverse certain types of arrhythmias

• Identify bleeding points after thyroid surgery

• In dentistry, check for oral-sinus communication after upper back tooth extraction

• Help diagnose varicocele and hernias

• Assess autonomic nervous system function

This technique may also help relieve the feeling of a blocked ear, especially during takeoff or landing on an airplane.

How it should be done

To perform the Valsalva maneuver, start by sitting or lying down. Take a deep breath, then close your mouth and pinch your nose with your fingers. Try to exhale forcefully without letting any air out. Maintain this pressure for about 10 to 15 seconds.

The movement used in this maneuver is similar to everyday actions like straining during a bowel movement or playing a wind instrument like the saxophone.

Phases of the Valsalva maneuver

The Valsalva maneuver can help manage heart rhythm issues like arrhythmias and may improve the detection of heart murmurs. This happens due to physiological changes in the body that occur during the maneuver, which are divided into four phases:

• Phase I: The initial increase in chest pressure from holding the breath causes a temporary rise in blood pressure, due to a shift of blood from large veins and reduced circulation to the lungs
• Phase II: Chest pressure continues and reduces the return of blood to the heart, leading to a drop in blood pressure and a compensatory increase in heart rate
• Phase III: As the maneuver ends, chest muscles relax and blood pressure drops slightly further
• Phase IV: Blood flow returns to normal, stabilizing circulation and causing a slight rise in blood pressure

These phases happen quickly and are not easily noticed during the maneuver, though people who tend to have low blood pressure may feel its effects, such as lightheadedness or dizziness.

Possible side effects

The Valsalva maneuver is generally safe, but in some cases, it may cause chest pain, irregular heartbeat, or vasovagal syncope, which involves a sudden loss of consciousness followed by fainting.

When it is not recommended

The Valsalva maneuver is not recommended for people with retinal problems, such as retinal detachment, or those with ocular lens implants, high intraocular pressure, or congenital heart disease. This is because the blood pressure changes caused by the maneuver could worsen these conditions.