{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:41:44Z","timestamp":1787013704265,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,9,22]],"date-time":"2016-09-22T00:00:00Z","timestamp":1474502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Forensic Sciences"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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 \u201ccommode cardia,\u201d has not been examined. In 2012, the Wayne County Medical Examiner's Office (Detroit,\n                    <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n                    ) 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\u2010related deaths.\n                  <\/jats:p>","DOI":"10.1111\/1556-4029.13196","type":"journal-article","created":{"date-parts":[[2016,9,22]],"date-time":"2016-09-22T10:33:11Z","timestamp":1474540391000},"page":"1541-1545","source":"Crossref","is-referenced-by-count":14,"title":["Commode Cardia\u2014Death by Valsalva Maneuver: A Case Series"],"prefix":"10.1111","volume":"61","author":[{"given":"Amanda O.","family":"Fisher\u2010Hubbard","sequence":"first","affiliation":[{"name":"Department of Pathology University of Michigan 1301 Catherine Street Ann Arbor MI 48109"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kilak","family":"Kesha","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Michigan 1301 Catherine Street Ann Arbor MI 48109"},{"name":"Wayne County Medical Examiner's Office 1300 E. Warren Avenue Detroit MI 48207"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Michigan 1301 Catherine Street Ann Arbor MI 48109"},{"name":"Wayne County Medical Examiner's Office 1300 E. Warren Avenue Detroit MI 48207"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantel","family":"Njiwaji","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Michigan 1301 Catherine Street Ann Arbor MI 48109"},{"name":"Wayne County Medical Examiner's Office 1300 E. Warren Avenue Detroit MI 48207"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PaoLin","family":"Chi","sequence":"additional","affiliation":[{"name":"Integrated Healthcare Association 3100 E. Eisenhower Parkway Suite 100 Ann Arbor MI 48108"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl J.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Michigan 1301 Catherine Street Ann Arbor MI 48109"},{"name":"Wayne County Medical Examiner's Office 1300 E. Warren Avenue Detroit MI 48207"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.99.9.448"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.03.055"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.3.1.35"},{"key":"e_1_2_7_5_1","volume-title":"De aure humana tractatus","author":"Valsalva AM","year":"1707"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2005.01.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-77-3-357"},{"key":"e_1_2_7_8_1","first-page":"78","article-title":"Bed pan deaths","volume":"60","author":"McGuire J","year":"1948","journal-title":"Trans Am Clin Climatol Assoc"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0306-9877(90)90128-2"},{"issue":"1","key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.0954-6820.1968.tb02423.x","article-title":"Ventricular arrest caused by the Valsalva maneuver in a patient with Adams\u2010Stokes attacks accompanying defecation","volume":"184","author":"Schartum S","year":"1968","journal-title":"Acta Med Scand"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437740.48606.d1"},{"issue":"2","key":"e_1_2_7_12_1","first-page":"51S","article-title":"Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults \u2013 the evidence report. 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