Valsalva in echocardiography

Definition of adequate Valsalva: Pressure of 40mmHg against a closed glottis

Uses:

Diastolic dysfunction	Phase II	Differentiate between normal and pseudonormal*
Interatrial communication (PFO/ASD)	Phase III (release of valsalva, increased RA pressure)
Hypertrophic cardiomyopathy	Phase II	Provoke gradients (exercise provokes higher gradients)

*With adequate Valsalva E velocity should decrease by 20cm/s

Decrease in E/A ratio by ≥50% is specific for increased filling pressures (pseudonormal pattern at rest)