Physical Maneuvers
A number of physical maneuvers increase AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are collectively referred to as vagal maneuvers.
The Valsalva maneuver should be the first vagal maneuver tried and works by increasing intra-thoracic pressure and affecting baroreceptors (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold his/her breath and try to exhale forcibly as if straining during a bowel movement. Holding the nose and exhaling against the obstruction has a similar effect.
There are other vagal maneuvers including: holding one's breath for a few seconds, coughing, plunging the face into cold water, (via the diving reflex), drinking a glass of ice cold water, and standing on one's head. Carotid sinus massage, carried out by firmly pressing the bulb at the top of one of the carotid arteries in the neck, is effective but is often not recommended in the elderly due to the potential risk of stroke in those with plaque in the carotid arteries.
Read more about this topic: Supraventricular Tachycardia, Treatment
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