Vagal (Valsalvan) Maneuvers
Vagal maneuvers, or vagals, as we like to call them, are the first line treatment for terminating supraventricular tachycardia (SVT) in the patient who is physiologically stable, and able to follow commands - Clare Hunter RN
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image by: Medicine Keys for Internal Medicine
HWN Suggests
Slow down, you’re going too fast: SVT and The Modified Valsalva Maneuver
Vagal maneuvers are quick, painless, and completely free, and most certainly the preferred primary treatment for SVT in the stable patient. They are accompanied by none of the sense of impending doom experienced by patients receiving Adenosine, nor the electrifying (and costly) experience of cardioversion. Although the Valsalva technique is the most commonly used of the vagal maneuvers, there are several other physical actions which affect vagal tone. Ice to the face is frequently used with infants and children who are too young to follow commands, which elicits the ‘diving reflex’. Carotid sinus massage is still used, though with caution, and is a method contraindicated in the elderly because…
Resources
Pediatrics
Get them inverted… safely! The inverted position can have improved rates of cessation of SVT. Whether by feet elevation, or handstand, or by just holding the young ones upside down, there appears to be an augmented vagal response. Just don’t drop the kid!
“Home remedies” for SVT
There are a few ways a parent or caregiver can provide SVT treatment at home, and these involve stimulating the vagus nerve to return the heart rate back to normal. If your child looks ill during SVT or SVT doesn’t stop with these methods, your child will need care from a professional...
Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis
We recommended MVM as the first choice of VagM for rhythm conversion before the pharmacological management of SVT.
Enhance the valsalva to (actually) terminate SVT
My initial treatment for stable SVT was a rapid intravenous push of adenosine because of its high efficacy in terminating SVT. However adenosine results in transient asystole and a feeling of imminent death that many patients find unpleasant and frightening.
Modified valsalva versus standard valsalva for cardioversion of supraventricular tachycardia: systematic review and meta-analysis
Vagal maneuvers are recommended as a first-line modality for terminating supraventricular tachycardia (SVT) in the emergency department (ED) with the standard valsalva maneuver (SVM) being most commonly used]. Despite the wide adoption of the SVM in adults presenting with SVT, the efficacy as a sole method in restoring sinus rhythm in such patients is less than 25%.
The effectiveness of the Valsalva Manoeuvre for stopping an abnormal heart rhythm
We did not find sufficient evidence to support or refute the effectiveness of VM for termination of SVT.
The use of vagal manoeuvres in narrow complex tachyarrhythmias in primary care
The American Heart Association holds that vagal manoeuvres are a first-line therapy in the management algorithm of stable SVTs. However, they state that no clear recommendations can be made around which manoeuvre to use, highlighting that future research should examine the efficacy and safety profiles of the various manoeuvres.
Vagal Maneuvers with Supraventricular Tachycardia
Multiple variations of VM have been used in medicine. These include... Bearing Down: Medically referred to as the Valsalva Maneuver, this technique is one of the most common ways to stimulate the vagus nerve. The patient is instructed to bear down as if they were having a bowel movement. In effect, the patient is expiring against a closed glottis. An alternative way to perform a Valsalva Maneuver is to tell the patient to blow through an occluded straw or barrel of a 10 ml syringe for 15-20 seconds. These maneuvers increase intrathoracic pressure and stimulate the vagus nerve.
Slow down, you’re going too fast: SVT and The Modified Valsalva Maneuver
Vagal maneuvers, or vagals, as we like to call them, are the first line treatment for terminating supraventricular tachycardia (SVT) in the patient who is physiologically stable, and able to follow commands.
