Commonly used respiratory and pharmacologic interventions in the echocardiography laboratory.

Respiratory and pharmacologic interventions are used during auscultation of heart sounds. These same principles may be utilized in the echocardiography laboratory to aid diagnosis. Four physical maneuvers and one pharmacologic intervention performed in the echocardiography laboratory are described. A brief discussion of applications in specific clinical situations is then presented. The Valsalva maneuver involves having the patient inspire deeply followed by a forceful exhalation against a closed glottis for approximately 10 seconds. Placing the hand on the patient’s abdomen by the examiner provides a force for the patient to strain against and ensures that the abdominal muscles are tightening.1 Some patients who have difficulty with this may find it best to insert their index finger in the mouth and attempt to blow out with lips sealed. Alternatively, the patient may blow into a manometer to maintain 40 mmHg or more.2 The Valsalva maneuver involves the following four phases: