Commode Cardia—Death by Valsalva Maneuver: A Case Series

Abstract

The Valsalva maneuver is used in clinical medicine for the diagnosis and/or treatment of various cardiovascular conditions. It can also be used in activities of daily living, such as defecation. Due to the cardiovascular effects produced during the Valsalva maneuver, it may be contraindicated in certain medical conditions and could be a trigger of sudden cardiac death. The incidence and prevalence of death following Valsalva maneuver in the presence of underlying cardiovascular disease, or "commode cardia," has not been examined. In 2012, the Wayne County Medical Examiner's Office (Detroit, MI) investigated 21 deaths that occurred on the toilet, fourteen of which were due to cardiovascular disease. In another 31 deaths in the bathroom due to cardiovascular disease, the possibility that the decedent defecated immediately prior to death could not be excluded. Hence, the incidence of commode cardia in this population ranges from 2.3 to 7.4% of all cardiovascular-related deaths.

Unusual Cause of Cardiac Arrest

“…Fisher-Hubbard et al estimated the outpatient incidence of defecation-induced cardiac arrests as 2.3% to 7.4% in patients with cardiovascular disease. Kiyohara et al identified that 4.6% of out-of-hospital cardiac arrest occurred inside the restroom, and the number of patients with the initial shockable rhythm was 5.2%.…”

Buccal abscess derived from subcutaneous emphysema caused by the Valsalva maneuver after oral surgery with pedicled buccal fat pad grafting

“…A similar effect may occur as a result of the VM being performed during defecation. 23 Previously reported complications induced by the VM during defecation include cardiac arrest and other cardiovascular events, 23,24 but there have been no reports of the VM causing facial subcutaneous emphysema after oral surgery with PBFPG. The present patient developed tardive facial swelling 7 hours after the surgery.…”

Pharyngeal observation via transoral endoscopy using a lip cover‐type mouthpiece

“…However, in our daily clinical practice, it takes approximately 20 to 45 s to perform the Valsalva maneuver per examination (Valsalva maneuvers are performed two to three times per examination at 10–15 s per maneuver). Based on previous reports, the possibility of adverse events, such as cardiovascular complications and Valsalva retinopathy, should be considered . Second, two endoscopists trained in pharyngeal observation performed this technique.…”

“…Based on previous reports, the possibility of adverse events, such as cardiovascular complications and Valsalva retinopathy, should be considered. 15,16 Second, two endoscopists trained in pharyngeal observation performed this technique. Therefore, our results may not be generalizable.…”