Abnormal Valsalva Maneuver Is Not Always a Sign of Congestive Heart Failure  Satish R. Raj, MD, MSCI, David Robertson, MD, Italo Biaggioni, MD, André Diedrich,

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Abnormal Valsalva Maneuver Is Not Always a Sign of Congestive Heart Failure  Satish R. Raj, MD, MSCI, David Robertson, MD, Italo Biaggioni, MD, André Diedrich, MD, PhD  The American Journal of Medicine  Volume 120, Issue 6, Pages e15-e16 (June 2007) DOI: 10.1016/j.amjmed.2006.03.022 Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 1 Absent sympathetically mediated vasoconstriction in autonomic nervous system failure. The heart rate, blood pressure, and generated Valsalva pressure are shown top to bottom. The blood pressure decreases throughout the Valsalva maneuver without late recovery, and blood pressure after release of Valsalva does not recover back to the baseline blood pressure, let alone “overshoot” the baseline blood pressure. The American Journal of Medicine 2007 120, e15-e16DOI: (10.1016/j.amjmed.2006.03.022) Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 2 Square wave pattern Valsalva response in a healthy volunteer. The blood pressure paradoxically increases with Valsalva and stays elevated until the release of Valsalva. The American Journal of Medicine 2007 120, e15-e16DOI: (10.1016/j.amjmed.2006.03.022) Copyright © 2007 Elsevier Inc. Terms and Conditions