Studies of Circulation Time During the Val - salva Test in Normal Subjects and in Patients with Congestive Heart Failure

Circulation times (P32 from the antecubital and femnoral veins to a peripheral artery) and roentgenographic studies of the pattern of venous distribution of a radio-opaque substance (Diodrast introduced through a cardiac catheter into the axillary vein and'the inferior vena cava below the diaphragm) have been performed during the expiratory effort of the Valsalva maneuver. In normal subjects the circulation times were increased by the duration of the expiratory effort and the Diodrast injections were stagnated in the veins outside the thoracic cavity. These effects were in striking contrast to those in patients with congestive failure in whom the circulation times were retarded only partially if at all and the Diodrast injections continued to flow freely towards the right atrium during the expiratory effort. Thus, in patients with congestive failure the Valsalva maneuver does not interrupt the venous return to the right atrium as it does in normal subjects.