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, p448
Academic Journal
1. The effect of bowel straining on the cardiopulmonary system was studied in a group of normal and constipated subjects by observation of changes in the heart rate, electrocardiogram, heart sounds, pulmonary circulation and circulation time. 2. The presence of either a tachycardia or bradycardia occurring in connection with certain straining efforts of defecation as they affect the heart rate was confirmed. These alterations of the rate are reflexes principally associated with the Valsalva phenomenon. 3. The Valsalva maneuver initiated electrocardiographic changes in 2.5 per cent of the 209 healthy persons studied. These changes most often consisted of marked T-wave lowering and ST-segment depression. Other alterations included extrasystoles, partial heart block, slurring of the QRS-complex and T-P fusion. It was concluded that reduced coronary perfusion was the most likely causative factor for the abnormalities described. 4. The effect of bowel straining on heart sounds and murmurs appears to conform to the known dynamic results of straining at stool and the physiologic mechanism accountable for the acoustic phenomena. 5. The entire pulmonary circulation is a low tension system, indicating large channels of flow with low resistance. The effects of straining on the venous return to the heart from the pulmonary circuit, as well as the results of straining on pulmonary arterial, left atrial and pulmonary �capillary� pressures are discussed and related to the four phases into which the circulatory system's response to the Valsalva maneuver has been divided. 6. The effect of straining on the circulation time was studied in terms of strains of periods shorter than 10 seconds, along with the possible additive effects of individual strains of less than 6 seconds' duration would grossly affect the circulation time. However, sustained efforts exerted at pressures in excess of 10 mm Hg for more than 6 or 8 seconds would prolong circulation time in rough approximation to the duration of the strain. 7. The straining efforts in constipated individuals are greater and more profound than in normal individuals. The implication of this fact with respect to the cardiopulmonary dynamics of bowel function is discussed and the hazards involved are indicated. 8. The present findings emphasize the conclusion that physiologic changes after straining at stool may result in serious consequences, and, if tragic episodes are to be avoided, the immediate correction of constipation assumes special significance for persons who suffer from serious organic heart disease.


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