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The Bedside Valsalva Maneuver: A Continually Overlooked Clinical Tool

Michael J. Zema, MD
Arch Intern Med. 1993;153(17):2055. doi:10.1001/archinte.1993.00410170147015.
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Although encouraged by this type of basic clinical investigation, I am disappointed to see the recent study by Marantz et al1 neglect to include the simple sphygmomanometrically determined systolic arterial pressure response as a criterion for the diagnosis of congestive heart failure. Marantz has previously2 demonstrated the utility of the bedside Valsalva maneuver in evaluating the acutely dyspneic patient. While the diagnosis of congestive heart failure has no "gold standard," we and others have found an unsurpassed correlation between the pattern of arterial pressure response detected by use of the bedside Valsalva maneuver and objectively documented left ventricular systolic3,4 and/or diastolic5,6 function. Use of the patient-performed Valsalva maneuver at the bedside during careful practitioner auscultation of the brachial systolic arterial pressure requires merely a stethoscope, sphygmomanometer, and 30 seconds of time. Ease of determination, lack of need for specialized equipment, objectively measurable end points,5 semi-quantitative

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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