Valsalva maneuver in Emergency

This video shows a modified Valsalva maneuver being used in the emergency treatment of stable SVT supraventricular tachycardia.

This is a beautiful example of how manipulating the nervous system & leveraging physiology can be used as a simple, cost-free treatment. So, let's talk about why & how it works:

The modified Valsalva can be divided into 3 phases:

Phase 1: Increasing intrathoracic pressure: At the beginning of this video, you'll see the patient perform a standardized 'strain' blowing into a 10mL syringe for about 15 seconds while sitting up or in a semirecumbent position. Bearing down like this contracts the thoracic & abdominal muscles & causes a drop in blood flow back to the heart decreased preload & brain. This drop stimulates the baroreceptor reflex & compensates by triggering the sympathetic nervous system stress response in an attempt to raise the blood pressure, cardiac output & peripheral vascular resistance.

Phase 2: Causing a sudden drop in the intrathoracic pressure:

After the 15 second strain, just prior to being laid flat or simultaneously, the patient will stop blowing into the syringe, this causes the pressure in the thorax to suddenly decrease, subsequently increasing blood flow back to the heart & increasing the preload leading to the opposite of phase 1: a compensatory increase in parasympathetic vagalactivity aimed at decreasing heart rate + increasing the relaxation response.
Phase 3: Laying flat & raising the legs to 45 degrees:

This postural modification causes even more blood flow back to the heart, leading to an increase in stroke volume & cardiac output. This causes further vagal - parasympathetic - stimulation, which compensates for these changes by telling the body to decrease the heart rate via the SA node THIS can convert the patient back into sinus rhythm! A phenomenon beautifully depicted in this video!

[markoliverbryan]

thank you. this litirally just save my life now. i blew on my finger and flip my body leaning my thighs on the back of the couch.

[Radoslaw]

I know vegal manuvers. It stimulates the parasympathetic nerves system that slows the heart rate

[kozmasandor]

Thank you this real documentation. It's so much help me.

[LeeHanDSOME_BoyNextDoor]

He had a heart rate of over 200?! That's crazy. I remember one time I had a heart rate of 180 and it felt horrible. I was having 2 heart beats at the same time. I however didn't know of this maneveuer. I usually take Propranolol for fast heart rate but it takes some minutes for it to start taking effect, this maneuver definetely works a lot faster.

[ddas]

This is not normal valsalva, this is modified valsalva

[donttalkwet]

I had heart rate 240 they did this manouver to me first time final time they used a liquid to stop my heart for a second. Then I had the ablation to fix the svt and now it's fixed. It was a horrible experience having svt I recommend anybody with it to get the ablation

[thelogician]

One crucial thing to clarify: does any air actually gets blown out or the tube is completely blocked?

[HFH-Official]

Not the Valsalva... This is modified Valsalva maneuver. Learned this while in the Army, but it does have serious adverse effects from my understanding. Only used as last resort.

[TravelogsIndia]

Is it a permanent solution for heart rate like this?

[ramchandraiahram]

Dr i have sinus tachycardia but my doctor says it's normal what should I do

[miramar-]

great if you have a bunch of people to tip you up like that