Modified Valsalva

Honestly, I keep forgetting to try this. I have had no problem converting SVTs with Adenosine though (after attempting a regular Valsalva maneuver). None of my SVTs have converted with Valsalva, but one did convert with an IV stick (Valsalva = blow against closed airway so vagal-ing down isn't technically the same even though that is the end goal of Valsalva and modified Valsalva in our case). My understanding of modified Valsalva is similar to why sinus arrhythmia occurs. The transient increase in preload during passive leg raising causes an increase vagal stimulation.

Alameda County, California is implementing this in their protocol.
 
I haven't ever actually even seen SVT, so my pool of experience to draw from with SVT a fat 0. I will definitely try this when I get the chance though.
 
Hmm, interesting thanks for sharing. Didn't see this article last time I was on the site.
 
Our service teaches every one the modified valsalva. Collectively we have a decent conversion rate. I think I'm sitting around 40-50% success.

One of the keys I think is really encouraging the patients to blow and bear down for 15 seconds. When I've done this, I'm almost cheering them on. "Blow blow blow, you're doing really well, 10 more seconds, keep blowing, keep blowing, another 5 seconds, keep it up, blow blow blow, and relax." It seems silly to type out, but a lot of folks around here that do it like that have really good success converting SVTs.
 
Never tried this, though had an SVT the other day, converted with just blowing into a closed straw.... Well, a pen.

My first thought was "Well that's rude".:p;)
 
I saw a ER doctor do a similar maneuver on a pt that didn't respond to Adenosine or cardioversion. Have the pt lay flat, grab ankles, and bear down. I used this on my first SVT and converted immediately.
 
I've never seen it, but have only heard of it's effectiveness.
 
Our agency uses this exclusively before all other measures. If BP >100 then 3 x modified Valsalva manoeuvre before moving to Adenosine OR if rapid deterioration then immediate electronic cardioversion.

I have sued it a number of times with great success.
 
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