7 responses to “Enhance the valsalva to (actually) terminate SVT”

  1. Glad to see this article. I have been doing a modification to the sad old feeble yet standard vagal maneuver for about 18yrs. Once I have a sense that the patient is stable, I do 3 things – 1) 30-45deg of trendelenberg as explain to the patient what is going on,what will be going on,and why, 2) then after a couple of minutes I get the patient to do the valsalva and 3) immediately post valslava carotid sinus massage. My success rate is in the 40-50%. Anecdotely, patients that have a slight slowing of the heart rate when put into trendelenberg seem to be the most likely responders to the other vagal maneuvers.

    By the way I always check out these “This Changed my Practice” emails. Unusual not to find something useful.

  2. Most interesting. Like most I have been unimpressed by the valsalva technique to date, so this sounds very promising, a definite positive advance to be tried.

  3. I agree this does sound promising but I am going to experiment on myself to determine an easier measure of achieving a 40mm strain.
    I also have combined the Valsalva with carotid massage and gotten better results than valsava alone.

  4. This is such an interesting low cost and low risk intervention! For fun, today on rounds at the hospital I tried to see if healthy young nursing staff, residents, medical students and an attending could actually MOVE the 10cc syringe plunger. None of us could actually do it (even after breaking the seal, manually moving the plunger a few times or with water in the syringe). It definitely produces a strong vasalva so the goal of the effort is achieved but I’m not sure if we can expect patients to actually MOVE the plunger. Anyone else try to move the plunger themselves?

    Again, the method seems very useful and I’m looking forward to trying for SVT in the future!

  5. it is safe and effective and free, it is definitely good to use. excellent approach to the treatment no side effect.

  6. After being told about this modification,we tried to blow the syringe. Not easy. Lot of dizzy people. Sustained pressure seems to work. Was succesful on firs t patient we tried!

  7. I have not tried the syringe method, but get my patients to blow into a drinking straw and pinch the straw closed for the duration of exhalation, followed by trendelenburg positioning for about 30 seconds. I find this converts SVT in ~40% patients and works especially well in kids with SVT. (More fun for kids to have them try to blow bubbles in cup of water as you pinch straw, and gets them to blow longer.)

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