Valsalva ManÅuvre
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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