question: 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?