Heart Disease: The Valsalva Maneuver

People who suffer from the sudden, sharp chest pains called angina pectoris usually carry nitroglycerin pills or amyl nitrite for quick, dramatic relief. The frightening spasms commonly occur in long-standing heart disease patients when they exercise or are exposed to cold weather. But what is the victim to do if the pain strikes and he has forgotten his pill? A report in last week’s New England Journal of Medicine suggests an effective emergency treatment: when an attack takes place, hold the nose, close the mouth and blow.

Named the Valsalva maneuver, after the 17th century Italian anatomist who described it, the trick is the same used by air travelers and skin divers to clear their ears on descent. It also has much the same result as a dose of nitroglycerin or amyl nitrite. Both drugs are rapid dilators of the coronary arteries, and thus quickly increase blood flow within the oxygen-deprived heart muscle; the technique of blowing hard against resistance may work similarly, but, according to the Journal authors, the mechanism is not clear. The Valsalva maneuver should only be used in emergencies. It can be harmful in heart patients with acute attacks, severe high blood pressure, or a history of strokes.