The Emphysema Response to Forced Straining

R ECENTLY there has been a renewed interest in the physiologic effects of forced straining (Valsalva's maneuver). Particular emphasis has been placed on the blood pressure changes during and immediately after forced straining in an attempt to define more accurately the diagnosis of certain circulatory abnormalities, particularly hemodynamically significant mitral stenosis and the presence of congestive failure.1-7 Little attention has been given to the manner in which pulmonary disease modifies the response to straining. The purpose of this paper is to present data obtained from observing circulatory changes during and immediately after Valsalva's maneuver in patients with pulmonary emphysema and to contrast these changes with responses in patients with normal and diseased hearts. The "emphysema response" is unique and to our knowledge has not been described except in our recent preliminary report.8