Applications of the Valsalva maneuver in assessing the autonomic nervous system

초록

The Valsalva maneuver is a gold standard test for evaluating cardiovascular autonomic func tion. By inducing characteristic heart rate and blood pressure changes across four phases, it allows simultaneous assessment of sympathetic and parasympathetic responses. Quantita tive indices such as the Valsalva ratio, pressure recovery time, and baroreflex sensitivities pro vide precise evaluation of autonomic reflex pathways. Specific patterns like the square-wave phenomenon offer diagnostic clues to differentiate peripheral from central autonomic disor ders. This review summarizes the physiological mechanisms underlying the Valsalva maneu ver, key derived metrics, and examples of its clinical applications in diagnosing autonomic dysfunction in neurological disorders, including pure autonomic failure, Parkinson’s disease, and amyotrophic lateral sclerosis. Owing to its simplicity, noninvasiveness, and diagnostic utility, the Valsalva maneuver remains a fundamental tool in clinical and research settings for autonomic assessment.

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