Supraventricular tachycardia non-medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Non-medical Therapy
Acute Treatment
Physical Maneuvers
A number of physical maneuvers cause increased AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are therefore collectively referred to as vagal maneuvers.
The most effective of these is the modified Valsalva maneuver.[1] The Valsalva maneuver increases intra-thoracic pressure and affects baroreceptors (pressure sensors) within the arch of the aorta. This can be achieved by asking the patient to hold their breath and bear down as if straining to pass a bowel motion, or less embarrassingly, by getting them to hold their nose and blow out against it.
The modified Valsalva maneuver may be helpful. In this maneuver, the seated patient is asked to blow into a 10-mL syringe for 15 seconds and move the plunger. Then the patient quickly lays supine and lifts legs to a 45 degrees. Studies have repeated this from one to three times. Sinus rhythm resumed in 43%[2][3] of patients.
Less effective is carotid sinus massage to stimulate carotid baroreceptors.[4]
Plunging the face into, or just drinking a glass of ice cold water is also often effective.
References
- ↑ GitHub Contributors. Supraventricular tachycardia treatment with vagal maneuvers. GitHub. Available at https://openmetaanalysis.github.io/Supraventricular-tachycardia-treatment-with-vagal-maneuvers/. Accessed June 19, 2017.
- ↑ Çorbacıoğlu ŞK, Akıncı E, Çevik Y, Aytar H, Öncül MV, Akkan S; et al. (2017). "Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial". Am J Emerg Med. doi:10.1016/j.ajem.2017.05.034. PMID 28552271.
- ↑ Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A; et al. (2015). "Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial". Lancet. 386 (10005): 1747–53. doi:10.1016/S0140-6736(15)61485-4. PMID 26314489. Review in: Evid Based Med. 2016 Apr;21(2):61 Review in: Ann Intern Med. 2015 Dec 15;163(12):JC8 Review in: Evid Based Nurs. 2016 Jul;19(3):77
- ↑ Mehta D, Wafa S, Ward DE, Camm AJ (1988). "Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia". Lancet. 1 (8596): 1181–5. PMID 2897005.