Halpern, Alfred; Shaftel, Norman; Selman, David; Birch, Herbert G.
April 1958
Angiology;Apr1958, Vol. 9 Issue 2, p99
Academic Journal
1. A series of investigations utilizing several hundred patient observations wore carried out to determine the effects of defecation on circulatory function in presumably normal individuals and persons with chronic constipation. 2. It appears that during bowel function of apparently normal individuals, approximately 12 per cent of the straining episodes are of sufficient intensity and duration to satisfy the accepted criteria for the Valsalva maneuver, and that by substituting a bedpan for the commode, this incidence is more than doubled (28.0 per cent). Constipation, it may be noted, increases this frequency approximately fivefold (57.9 per cent). From the results of research presently underway, the use of a constipation corrective, Senokot, favorably modifies the magnitude and duration of straining among constipated individuals. 3. The established sequential changes in blood pressure of the Valsalva maneuver were found to occur during defecation in response to those strains meeting this criteria. While the height of the initial blood pressure rise was roughly proportional to the intensity of the effort in both groups, the constipated group had twice as many peaks above 60 mm Hg than did the normal group and conversely, the normals had three times as many peaks below 20 mm Hg as did the constipated series. 4. The peaks of the phase IV overshoot were not found to be related to the height of the original straining pressures exerted. The distribution of these peaks was comparable in both groups, when they occurred. 5. The Valsalva maneuver initiated electrocardiographic changes in approximately 20 JXT cent of the normal subjects studied. These changes included (1) ST depression, (2) flattening of the T wave, (3) poststraining arrhythmia, and (4) the reversal of a previously al)normal T wave to one which became fiat to upright. These abnormalities are generally associated with physiologic myocardial insufficiency. No significant abnormalities of the electrocardiogram were detected in the remaining 80.4 per cent of the over-all group performing the Valsalva maneuver. 6. The presence of either a tachycardia or a bradycardia occurring in connection with certain of the straining efforts of defecation was confirmed. These alterations of the rate arc reflexes principally associated with the Valsalva phenomenon. 7. It becomes apparent, therefore, that the physician must seriously consider the volatile effects and potential hazards of .stool-straining in his cardiac patients. Our data indicates that physiologic changes following straining at stool may result in serious consequences, and if tragic episodes are to be avoided, the immediate correction of constipation becomes of special importance to the patient with cardiovascular disease.


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