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Incorrect instruction in the use of the Valsalva manoeuvre for paroxysmal supra-ventricular tachycardia is common


  • David McD Taylor, MD, MPH, DRCOG, FACEM, Director of Emergency Medicine Research; Lu Fee Wong, BMedSci, Advanced Medical Science student.

    Conflicts of interests: None

 Associate Professor David Taylor, Department of Emergency Medicine, Royal Melbourne Hospital, Grattan St, Parkville, Vic. 3050, Australia. Email:


Objective:  Success rates for the Valsalva manoeuvre (VM) in treatment of paroxysmal supraventricular tachycardia (SVT) vary with performance technique. This study aimed to assess whether ED doctors instruct their patients to perform the recommended VM technique (supine position for 15 s).

Methods:  A multicentre, observational study of 35 ED registrars and 17 emergency physicians. Each doctor was asked to describe how he/she would instruct a patient in SVT to perform the VM.

Results:  Only five (9.6%) doctors would position their patient correctly and 31 (59.6%) would incorrectly instruct their patient to assume a sitting or semirecumbent position. Only five (9.6%) doctors would give specific instructions to blow for at least 15 s and 34 (65.4%) would instruct their patient to blow ‘as long as you can’. Only four (7.4%) doctors would use a sphygmomanometer to measure intrathoracic pressure during the VM. There were no significant differences (P > 0.05) between the registrar and physician group responses for any study endpoint.

Conclusion:  Few ED doctors correctly instruct their patients in the VM technique recommended for management of SVT. Hence, maximal vagal tone and SVT conversion rates may not be achieved in many cases. The use of the recommended VM technique is encouraged.