Berman, A. Joseph; Halpern, Alfred; Shaftel, Norman; Selman, David; Shaftel, Herbert E.; Kuhn, Paul H.; Samuels, Saul S.; Birch, Herbert G.
October 1960
Angiology;Oct1960 Part 2, Vol. 11 Issue 5, p437
Academic Journal
1. In normal dogs and monkeys, the Valsalva maneuver was found to produce a marked fall in carotid blood pressure with a simultaneous rise in jugular vein and cerebrospinal fluid pressures, parallelling the rise in intrathoracic pressure. In two human subjects without cerebrovascular disease, performance of the Vulsalva maneuver resulted in a brief rise in brachial and carotid arterial pressure, followed rapidly by a precipitous fall. 2. Electroencephalographic as well as angiographic studies in normal dogs demonstrated that performance of the Valsalva maneuver produces circulatory stasis sufficient to result in anoxic changes in the cortical cells. 3. It is emphasized that a transient fall in cerebral blood pressure, resulting in fluctuations in cerebral oxygen supply, may be particularly hazardous to patients with existent cerebrovascular disease. In such individuals, reduction of stresses to the cerebral circulation is of utmost importance. Since straining at stool is perhaps the most common source of such circulatory stress, and since the magnitude and duration of straining efforts are greatest among constipated patients, the correction of constipation becomes an essential part of the therapeutic regimen of patients with cerebrovascular or vascular disease.


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