Weekend Archives: Sully: The Valsalva and Stroke

[Mark Rippetoe]

The Valsalva & Stroke | Jonathon Sullivan

[Pater]

I have a question concerning Valsalva. It doesn’t really have to do with stoke and it may/may not have been addressed in previous articles; but how does Valsalva affect a bicuspid aortic valve? My dad has BAVD (bicuspid aortic valve disease) and I believe he still needs to be training (to GRADUALLY strength his heart and the rest of his 63yo body like is done on the NLP) but I need legitimate info to share (not just my opinion) so he (and my mom-the one with the real concern) can make an informed decision about his training.

[Jonathon Sullivan]

Short answer: We don't know.

Longer answer: It depends on his hemodynamics and lesion characteristics. BAV presents as a spectrum of valvular and hemodynamic phenotypes, and we don't t know the specifics of his lesion. IIRC, performance of a Valsalva is standard during imaging (echocardiography) for this pathology, and an echo would demonstrate the impact on his hemodynamics. In some cases, the lesion results in stenosis, in a few cases it causes the opposite (regurgitation).

Bottom line: cardiology clearance. Be prepared for them to say what most cardiologists still say about weightlifting: No. In this case, they may or may not have a slightly stronger argument.

Sorry we can't be more definitive.

[Joel Chapman]

Thank you again, Dr. Sullivan, for this well written article.

[Pater]

Ok thanks. If it were you (or your dad) what specific questions would you ask the cardiologist? Is it as simple as asking whether or not weight training is ok for him?

[Jonathon Sullivan]

Ok thanks. If it were you (or your dad) what specific questions would you ask the cardiologist? Is it as simple as asking whether or not weight training is ok for him?

I'd ask whether his valve was stenotic (tight) or insufficient (regurgitant, or loose). Neither is great, but a stenotic valve would really give me pause. There are relatively simple procedures to open up a stenotic valve. A regurgitant valve would probably worry me a little less, although this can also progress to heart failure, and can also be repaired. I would definitely ask if the were accompanying aortic root pathology or aortic dilatation, which is a Big Deal. I would ask what the echo showed with Valsalva, if repair is indicated for a healthy active individual who wants to train, if not why not, and yes, whether resistance training was ok.

If the answer was no, I personally would put Dr. Heart on the spot, and ask for data and numbers and rationale and estimates of real risk. (Mostly I would ask these followup questions out of spite, because I know that he knows that I know that he doesn't fucking know.)

But at the end of the day, the final choice, after consultation, is your Dad's. There are no guarantees...even with a normal valve. With organisms, it's always something. We're made to break. You pays your money and you takes your chances. There needs to be exercise, no matter what, but I, personally, would train. That's reasonable.

Some would not. That is also reasonable.

It's been said here before, and bears repeating, that this particular form of medicine, like all medicines, is not universal. Some can't or wont take it.

Bests.

[Comancheria]

Doc:

I will start out by saying, in writing, the following:

I hereby release everyone on Planet Earth from any responsibility whatsoever for my own use of the Valsalva maneuver. Should any lawyer claim otherwise—he can go fuck himself.

That having been said—I’m not certain I am actually doing the damned thing. The definition seems to be “...holding the breath AGAINST THE GLOTTIS.”

I am holding my breath during the execution of every rep—but is there some technique I should be doing with my glottis?

Thanks for all your assistance and your books.

Russ

[Mark Rippetoe]

If you are holding your breath and your cheeks are not puffed out, your glottis is involved.

[Comancheria]

Thanks. So I HAVE been doing it.

[Mark Rippetoe]

Sure. It's a normal human reflex.