Carotid massage for svt

A year-old women with a history of palpitations presented to the emergency department with a supraventricular tachycardia; the patient was cardiovascularly stable, carotid massage for svt. Carotid sinus massage CSM was performed to help identify the underlying rhythm. During massage the patient had an immediate cerebrovascular accident, resulting in a left hemiplegia.

The use of vagal stimulation to halt supraventricular tachycardia is a standard medical therapy. Two methods of vagal stimulation, the Valsalva maneuver and carotid sinus massage, have been used in urgent situations. Lim and associates compared the success rates of these two methods of vagal stimulation in terminating spontaneous supraventricular tachycardia in an emergency department setting. All patients with supraventricular tachycardia whose rhythm did not reveal obvious atrial flutter, atrial fibrillation or sinus tachycardia and who were hemodynamically stable were randomly assigned to undergo either the Valsalva maneuver or carotid sinus massage. Those who had carotid sinus massage were further randomized to undergo either right or left carotid sinus massage first.

Carotid massage for svt

Methods: This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients with regular narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic status. Results: One hundred forty-eight instances of SVT were studied Sixty-two patients underwent Valsalva maneuver first with conversion in 12 success rate of Eighty-six underwent CSM first with conversion in 9 success rate Carotid sinus massage was used in the 50 cases of SVT in which conversion was not achieved with the Valsalva maneuver. Conversion occurred in 7 cases success rate For the 77 cases of SVT in which initial CSM did not achieve conversion, conversion occurred in 13 with the Valsalva maneuver success rate Conclusion: Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM.

It is essential to understand that it is not always appropriate to have a patient attempt VM. You will be able to get a quick price and instant permission to reuse the content in many different ways. Vagal Maneuvers with Carotid massage for svt Tachycardia Vagal maneuvers are used as a first-line management tool with supraventricular tachycardia.

The first explanation behind the process of using a Valsalva Maneuver was described in by Hamilton et al. The pathophysiological basis of action of the four phases of the maneuver is based on the nature of increased refractoriness of AV nodal tissue, particularly on the effect of vagal activity. This occurs through increased intrathoracic pressure leading to baroreceptor stimulation, as demonstrated through the heart rate and blood pressure responses. The best available evidence currently, specifically the work of Taylor and Wong , supports the following three criteria in an evidence-based model of practice of the Valsalva Maneuver for SVT reversion in the emergency-care setting:. Patients should be instructed how to perform VM properly before attempting one. In addition, carotid massage is only recommended for select patients and may only be performed by a physician. It is essential to understand that it is not always appropriate to have a patient attempt VM.

Last Updated: September 16, Fact Checked. This article was medically reviewed by Jennifer Boidy, RN. Jennifer Boidy is a Registered Nurse in Maryland. There are 9 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 99, times. A carotid massage, often called a carotid sinus massage or CSM, is a medical maneuver used to slow down a dangerously rapid heartbeat in patients or to diagnose certain heart rhythm disturbances. The carotid artery carries blood to the brain, and an incorrectly performed CSM can cause serious health repercussions, especially in elderly patients. Do not perform this maneuver on yourself or another person unless you are a physician. National Institutes of Health Go to source.

Carotid massage for svt

The first explanation behind the process of using a Valsalva Maneuver was described in by Hamilton et al. The pathophysiological basis of action of the four phases of the maneuver is based on the nature of increased refractoriness of AV nodal tissue, particularly on the effect of vagal activity. This occurs through increased intrathoracic pressure leading to baroreceptor stimulation, as demonstrated through the heart rate and blood pressure responses. The best available evidence currently, specifically the work of Taylor and Wong , supports the following three criteria in an evidence-based model of practice of the Valsalva Maneuver for SVT reversion in the emergency-care setting:. Patients should be instructed how to perform VM properly before attempting one. In addition, carotid massage is only recommended for select patients and may only be performed by a physician. It is essential to understand that it is not always appropriate to have a patient attempt VM. For instance, if the patient has supraventricular tachycardia and is unstable, VM may delay definitive treatment such as cardioversion. Some potential complications include dizziness and an arrhythmia originating in the ventricles.

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During massage the patient had an immediate cerebrovascular accident, resulting in a left hemiplegia. If there was no recurrence during the observation period, the patient was discharged with an outpatient appointment. It is essential to understand that it is not always appropriate to have a patient attempt VM. Article menu. Register a new account? All patients with supraventricular tachycardia whose rhythm did not reveal obvious atrial flutter, atrial fibrillation or sinus tachycardia and who were hemodynamically stable were randomly assigned to undergo either the Valsalva maneuver or carotid sinus massage. Read the full text or download the PDF:. Lim SH, et al. If both methods of vagal stimulation failed, patients were managed with pharmacotherapy or cardioversion. The first explanation behind the process of using a Valsalva Maneuver was described in by Hamilton et al. Eighty-six underwent CSM first with conversion in 9 success rate These receptors trigger an increase in vagal tone, which stimulates a bradycardia response at the level of the AV node. Carotid sinus massage CSM was performed to help identify the underlying rhythm.

To diagnose supraventricular tachycardia SVT , a healthcare professional examines you and listens to your heart. A member of your care team takes your blood pressure. You are usually asked questions about your symptoms, health habits and medical history.

Eighty-six underwent CSM first with conversion in 9 success rate Some evidence indicates that the Valsalva maneuver is more efficacious in men and that carotid sinus massage is more efficacious in older patients. If the tachycardia was not terminated by the first method of vagal stimulation, the alternative maneuver was attempted. Lim and associates compared the success rates of these two methods of vagal stimulation in terminating spontaneous supraventricular tachycardia in an emergency department setting. All patients with supraventricular tachycardia whose rhythm did not reveal obvious atrial flutter, atrial fibrillation or sinus tachycardia and who were hemodynamically stable were randomly assigned to undergo either the Valsalva maneuver or carotid sinus massage. If both methods of vagal stimulation failed, patients were managed with pharmacotherapy or cardioversion. SVT is a generic term applied to any tachycardia originating above the ventricles and which involves atrial tissue or atrioventricular AV nodal tissue. Lim SH, et al. Those who had carotid sinus massage were further randomized to undergo either right or left carotid sinus massage first. A total of episodes of supraventricular tachycardia occurred among patients. The Valsalva maneuver was performed by blowing into a mouthpiece with sustained resistance for 30 seconds or more. The fast pathway inputs near the compact AV node, and the slow pathway inputs near the os of the coronary sinus. Given the prevalence of atherosclerotic vascular disease in the general population and the safe alternatives available, it is recommended that CSM not be used for the termination of narrow complex tachycardia in the elderly population. Latest content Current issue Archive Authors About. Methods: This prospective, randomized case study was performed in the ED of a tertiary care institution.