The Bedside Valsalva Maneuver: A Continually Overlooked Clinical Tool

Although encouraged by this type of basic clinical investigation, I am disappointed to see the recent study by Marantz et al¹neglect to include the simple sphygmomanometrically determined systolic arterial pressure response as a criterion for the diagnosis of congestive heart failure. Marantz has previously²demonstrated the utility of the bedside Valsalva maneuver in evaluating the acutely dyspneic patient. While the diagnosis of congestive heart failure has no "gold standard," we and others have found an unsurpassed correlation between the pattern of arterial pressure response detected by use of the bedside Valsalva maneuver and objectively documented left ventricular systolic³,⁴and/or diastolic⁵,⁶function. Use of the patient-performed Valsalva maneuver at the bedside during careful practitioner auscultation of the brachial systolic arterial pressure requires merely a stethoscope, sphygmomanometer, and 30 seconds of time. Ease of determination, lack of need for specialized equipment, objectively measurable end points,⁵semi-quantitative