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Proposal intensity adequacy of expiratory effort and heart rate behavior during the valsalva maneuver in preadolescents.

Paschoal MA, Donato Bde S, Neves FB - Arq. Bras. Cardiol. (2014)

Bottom Line: These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests.The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM.Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

View Article: PubMed Central - PubMed

ABSTRACT

Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values.

Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance.

Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests.

Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities.

Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

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Heart rate (HR) tacogram (HR – bpm) recorded during the Valsalva maneuver(VM) performed by a 10-year-old preadolescent and with a resistanceequivalent to 60% of MEP. Observe the beginning and the end of theemphasized maneuver effort and the respective 20 s time for theexpiratory effort made with the closed glottis. Also, observe the sinusbradycardia after the maneuver.
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f01: Heart rate (HR) tacogram (HR – bpm) recorded during the Valsalva maneuver(VM) performed by a 10-year-old preadolescent and with a resistanceequivalent to 60% of MEP. Observe the beginning and the end of theemphasized maneuver effort and the respective 20 s time for theexpiratory effort made with the closed glottis. Also, observe the sinusbradycardia after the maneuver.

Mentions: The examiner followed the participant's effort and carefully observed forpressure oscillations to instruct the participant to avoid them when theyoccurred. The maximum acceptable oscillation was ±5 cm H2Orelative to the predicted effort. The participants were allowed a rest period ofat least 5 min between each VM to recover. The resistance values for the threemaneuvers were presented in order. The participant's HR was recorded during VMwith a HR monitor belt (Polar heart frequency meter, S810i®,Kempele, Finland) that the participant wore around the thorax. The HR data weresent to a computer via an infrared interface and were processed using themanufacturer's software (Polar Precision Performance®, KempeleFinland), which computed a HR graph (Figure1) and a report for the cardiovascular measures.


Proposal intensity adequacy of expiratory effort and heart rate behavior during the valsalva maneuver in preadolescents.

Paschoal MA, Donato Bde S, Neves FB - Arq. Bras. Cardiol. (2014)

Heart rate (HR) tacogram (HR – bpm) recorded during the Valsalva maneuver(VM) performed by a 10-year-old preadolescent and with a resistanceequivalent to 60% of MEP. Observe the beginning and the end of theemphasized maneuver effort and the respective 20 s time for theexpiratory effort made with the closed glottis. Also, observe the sinusbradycardia after the maneuver.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150666&req=5

f01: Heart rate (HR) tacogram (HR – bpm) recorded during the Valsalva maneuver(VM) performed by a 10-year-old preadolescent and with a resistanceequivalent to 60% of MEP. Observe the beginning and the end of theemphasized maneuver effort and the respective 20 s time for theexpiratory effort made with the closed glottis. Also, observe the sinusbradycardia after the maneuver.
Mentions: The examiner followed the participant's effort and carefully observed forpressure oscillations to instruct the participant to avoid them when theyoccurred. The maximum acceptable oscillation was ±5 cm H2Orelative to the predicted effort. The participants were allowed a rest period ofat least 5 min between each VM to recover. The resistance values for the threemaneuvers were presented in order. The participant's HR was recorded during VMwith a HR monitor belt (Polar heart frequency meter, S810i®,Kempele, Finland) that the participant wore around the thorax. The HR data weresent to a computer via an infrared interface and were processed using themanufacturer's software (Polar Precision Performance®, KempeleFinland), which computed a HR graph (Figure1) and a report for the cardiovascular measures.

Bottom Line: These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests.The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM.Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

View Article: PubMed Central - PubMed

ABSTRACT

Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values.

Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance.

Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests.

Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities.

Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

Show MeSH