Valsalva Manœuvre

Report:

Top:

Sinus rhythm & arrhythmia

Blocked SVEB (first pause)

Second degree AV block (second pause)

Junctional escape beat

Bottom:

Sinus rhythm & arrhythmia

First degree AV block

Sinus arrest

Comment:

The vagal reflex triggered by the inspiratory hold caused both sino-atrial and AV nodal blocks.

Movement of the endotracheal tube during disconnection from the ventilator and suctioning of the tube may cause similar effects, sometimes preventable by IV xylocaine. The Valsalva equivalent of forced inspiratory hold is not.

Fig 134. 70 year old man with ischæmic COCM, dying from gas gangrene of the abdominal wall following a cholecystectomy. The bigeminy shown was recorded one hour before death.

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