Modified Valsalva Maneuver

Q: What is "modified Valsalva maneuver"? 


Answer:

In normal Valsalva maneuver the patient either in a supine or semirecumbent position is asked to  exhale forcefully against a closed glottis after a normal inspiratory effort (technically should be at 40 mmHg pressure) for about 15 seconds. Good Valsalva maneuver is marked by neck vein distension and increased abdominal wall muscles tone. 

Modified Valsalva maneuver, which involves the standard Valsalva maneuver in the semirecumbent position is followed by supine repositioning with 15 seconds of passive leg raise at a 45 degree angle.

It is claimed that modified Valsalva maneuver is more successful in restoring normal sinus rhythm in supra-ventricular tachycardia (SVT).

#cardiology


Reference: 

Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015; 386:1747.