Q. Immediately after doing Valsalva maneuver, why do I have trigeminal pulse?

Answered by
Dr. Muhammad M. Hanif Md.
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 02, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a male, who is 5.6 feet tall and weigh 172 lbs. I have head and chest pains for over five years. Currently, I take Metoprolol, Amlodipine, Losartan, and Prednisone. My pulse and heart rates are normally regular, but immediately after doing Valsalva maneuver, it becomes trigeminal pulse. This is very repeatable. It returns to normal after about 10 to 15 minutes. What could cause this?

Dr. Muhammad M. Hanif Md.

Cardiology Critical Care Physician General Medicine Internal Medicine


Welcome to icliniq.com.

I have carefully reviewed your case and understand that you are worried about your heart beats and pulse after doing Valsalva maneuver.

  • The trigeminal pulse is defined as the one with a pause after every third heart beat. It is usually due to the underlying process called premature ventricular contractions (PVCs), and in older adults, it is common. It warrants further investigations although it is quite regular in occurrence and is prevalent in a large group of people in older age.
  • It feels our heart is skipping a beat, and sometimes there is a tiny early beat followed by a delay that may go longer and gives the feeling of a pause. We can see a bigeminal or a trigeminal PVC in patients. In bigeminal PVC there is one abnormal PVC cycle and one normal one. In trigeminal, there is PVC in combination with two normal cycles of heart beats (one skipped beat with two normal beats of the heart).
  • Less serious causes may include, certain medications, caffeine, life stress, alcohol use, and remaining attentive for long times with a lack of sleep in between. Proper sleep is necessary for life to go on in normal rhythm. Seriously alarming causes may include heart rhythm diseases, diseases of valves of the heart and coronary artery disease.
  • My final impression is, please make an appointment with a cardiologist for proper evaluation and diagnosis if there is any underlying disease of the heart going on. Management depends mainly on the diagnosis.

Hope it helps. Please feel free to contact me back if you need further assistance. I would be happy to help. Regards.

For further queries consult an internal medicine physician online --> https://icliniq.com./ask-a-doctor-online/internal-medicine-physician

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Thank you doctor,

I understand bigeminy and trigeminy, and occasionally it occurs at rest. I should have also said that I have both pulmonary sarcoidosis and neurosarcoidosis. I have been assured that I do not have cardiac sarcoidosis, but I have a lot of unusual imaging, which comes and goes. I am trying to understand the dynamics on why Valsalva might cause the rhythm change, it might be another piece of the puzzle.

Dr. Muhammad M. Hanif Md.

Cardiology Critical Care Physician General Medicine Internal Medicine


Welcome back to icliniq.com.

  • I can realize that you are concerned more about the underlying reasons behind changing heart beats and pulse with Valsalva maneuver. Valsalva is implied to see if there is anything bad going on with the heart regarding its pumping function (electrical and mechanical processes that lead to synchronous pumping of the heart).
  • Valsalva increases load on the heart, and we see how heart behave on this increased afterload. Valsalva increases the pressure in the chest, which affects the heart too. It reduces filling of heart and changes blood pressure (rises and then falls). Heart rate is also affected, and we see how heart takes its dynamics back to normal. Usually, we use Valsalva to differentiate heart disease like murmurs of the heart.
  • Pulmonary sarcoidosis may affect lungs function depending upon the advancement of the disease. This may affect Valsalva to some extent too. But that is compensated and ruled out when we go for further heart evaluation.
  • If your cardiologist finds something on investigations, it can be evaluated accordingly. Otherwise, it can fall under the category of less serious causes aforementioned. Lifestyle changes can then be helpful.

Hope this helps. Please feel free if you need further assistance. I am here to help. Regards.

For more information consult an internal medicine physician online --> https://icliniq.com./ask-a-doctor-online/internal-medicine-physician

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