Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

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Question 20 of 39:

Since this patient is less than 45 years of age he should be encouraged to perform isometric exercise and Valsalva maneuvers to hasten recovery.

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Avoidance of Valsalva maneuver is the only coronary precaution of universal significance. Age attenuates autonomic cardiovascular responsiveness [1-4] so avoiding the use of the Valsalva maneuver may be especially important in persons <45 years old. Stool softeners should be prescribed routinely, and a bedside commode rather than a bedpan should be used by all but the most unstable patient. Forced expiration against a closed glottis causes sudden and intense changes in systolic blood pressure and heart rate. Changes in ventricular loading during the Valsalva maneuver may influence regional endocardial repolarization and predispose the patient to ventricular arrhythmias [5].

Reference:

1. Metzger BL, Therrien B. Effect of position on cardiovascular response during the Valsalva maneuver. Nurs Res 1990;39:198-202.

2. Folta A, Metzger BL, Therrien B. Preexisting physical activity level and cardiovascular responses across the Valsalva maneuver. Nurs Res 1989;38:139-143.

3. Porth CJ, Bamrah VS, Tristani FE, Smith JJ. The Valsalva maneuver: mechanisms and clinical implications. Heart Lung 1984;13:507-518.

4. Strom DS, Metzger BL, Therrien B. Effects of age on autonomic cardiovascular responsiveness in healthy women and men. Nurs Res 1989;38:326-330.

5. Taggart P, Sutton P, John R, Lab M, Swanton H. Monophasic action potential recordings during acute changes in ventricular loading induced by Valsalva maneuver. Nurs Res 1989;38:139-143.