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What is it used for?
It is used in stable patients with SVT to increase vagal tone and slow conduction through the atrioventricular (AV) node.
Mechanism of action – Phase 1 - Onset strain
Increased intrathoracic pressure: Brief ↑ BP
Mechanism of action – Phase II – Continued Strain
Reduced venous return: ↓ BP, reflex ↑ HR
Mechanims of action - Phase III – Release of Strain
Release of strain - Brief ↓ BP
Mechanism of action - Phase IV – Recovery/Overshoot
Venous return and BP overshoot: ↑ Vagal tone → slows AV node → may terminate SVT
Indications
Haemodynamically stable SVT patient
Contraindications (hungry, acute, aortic, raging, rabbits, grab, red, 3s)
Hypotension, AF, Aortic stenosis, recent MI with 3 months, requirements for immediate cardioversion, glaucoma, retinopathy, 3rd trimester of pregnancy
Complication
Syncope, prolonged hypotensive state
Limitations of this manoeuvre
Can only be done a maximum of three times