Modified positional valsalva

Background

2015 REVERT Trial

• Studied modified Valsalva for SVT conversion to normal sinus:
  • Normal Valsalva - 17% resolution
  • Modified Positional Valsalva - 43% resolution
• No adverse events or costs associated with Modified Positional Valsalva

Modified positional valsalva

Set-up

• 10ml syringe with plunger
• Two assistants - one to adjust head of bed and another to raise/lower legs.

Steps

1. Position patient with legs flat and head of bed to 45°
2. Have patient attempt to blow out plunger of 10ml syringe (or Valsalva around 40mmHg) for 15 seconds
3. Quickly reposition patient's head of bed to flat and have the other assistant raise legs to 45° for another 15 seconds
4. Return head of bed to 45° and continue to monitor for resolution for 1 minute
5. Repeat if needed

External Links

• Video explaination and demonstration of Modified Positional Valsalva
• The Lancet: REVERT Trial
• https://www.medmastery.com/magazine/modified-valsalva-maneuver-video-review

See Also

• Vagal maneuvers
• SVT