Useful technique for SVT attacks

Hi Simon, I just want to thank you for your post. I read it this morning and after an attack this evening I tried it and within 30 seconds my pulse was back to normal.

I have been suffering this for 30 years and only just recently found out my fast pulse was actually SVT.

At least I know how to manage it in the future.

 

  I am so glad I found this website!  I am immensely grateful to all of you who have posted.  You have shown me that my own SVT, which I have had for two years and is getting worse, is nowhere near as bad as some people’s, and that it can be managed more effectively.  The tips on reverting SVT have been invaluable.  If I can’t revert my SVT immediately with the Modified Valsalva Manoeuvre or carotid massage, I then run through a list of other manoeuvres, some of them unpleasant or inconvenient, and usually none of them work.  Then I may resort to taking the pills, but they don’t work very well for me, and I don’t get back to fully normal for several days.

This morning, during an attack, after all the usual tricks didn’t work, I tried lying on my right side in the foetal position.  It didn’t work for me.  I then tried getting down on my hands and knees, putting my head between my knees and holding my breath.  That didn’t work, but when I tried it again but standing on my feet instead of my knees, bingo!  I reverted straight away and went for a 45 minute run to celebrate.  I was so happy that I wasn’t going to have to endure days of inactivity until I reverted.

I have compiled a list of reversion manoeuvres that some may find useful.  It seems that what works for one person does not work for another, and what works one time for you may not work another time.  So it can be useful to have a list to hand, as below. I have put some of the ones posted on this forum  at the top, as they are ‘real world’ manoeuvres rather than what the doctors tell you to do, which may or may not work for you.  Some of the ones on this forum I didn’t post because they are standard ones already generally known about, and are already in my list further down the page.

Some remedies from this forum:

Foetal position (posted by Simon): Lie on your right hand side, curl up into a bit of ball (i.e. knees tucked up and head forwards, foetal position) and then just completely relax, make sure you're horizontal, especially your head and neck.. Funnily enough lying on my left hand side can sometimes trigger SVT. I've noticed it doesn't always work straight away. The last time it took a few attempts and bit of walking about and stretching my chest (you know like when you're tired or yawning, and you arch your back and reach your hands behind your head), but it did work eventually after about ten minutes. I think sometimes the heart needs to tire a little before it can go back into its normal rhythm.

All Fours (posted by Sofie): The one thing that is failsafe for me is getting on all fours then tucking my head under as close to my knees as possible and holding my breath.

Relax (posted by davejey): The only way I could deal with an attack was to lie down flat on my stomach on the carpet and relax completely and make sure I am aware of my regular breathing. Usually after 5 or ten minutes it would reset.

Belly Breath (posted by DR1983): negative breathing, i.e. when I expel the air I concentrate in the belly and let the force of the breathing move to the lower belly, as far down as possible.

Handstand (posted by nikkihar22): Do a hand stand using a wall behind you for stability if needed. The most important factor is to shock the body and by making all the blood rush to your upper body, your heart gets enough blood and you should be back to normal within 7 seconds.

Muller's Manoeuvre (posted by steveng56):  exhaling, then blocking my airway while trying HARD to breathe in (the negative pressure really feels weird)...it worked in just a few seconds!

Fast drink (posted by stev63016): stand straight upright and drinking 600 or 700ml of water (colder the better but doesn't matter) as fast as you can in 2 -3 gulps. Then as you swallow the last mouth full, lie down flat and stay still for 30 seconds. If it doesn't work, repeat steps again.

Squat (posted by tim98814): put your hands on a wall, and squat down quickly and remain in that position with your head down and holding your breath, or breathing very shallowly. It can take a couple of tries.

From medical sources

Modified Valsalva:

In a semi-recumbent position patients produce 40mmHg pressure for 15 seconds (or blow on a 10 ml syringe to make it move slightly) while bearing down and then repositioned in a supine position with legs elevated by a staff member to 45 degrees for 15 seconds immediately after the valsalva strain. Patients were then returned to a semi recumbent position for 45 seconds before their cardiac rhythm was reassessed by a three lead ECG. 

Notes: Bearing down, which medically is referred to as the Valsalva manoeuvre, is one of the most common ways to stimulate the vagus nerve. The patient is instructed to bear down as if they were having a bowel movement. In effect, the patient is expiring against a closed glottis.  Bearing down means that you try to breathe out with your stomach muscles but you don't let air out of your nose or mouth. Your doctor might recommend that you do these actions while you lie down on your back.

Coughing: Coughing creates the same physiological response as bearing down, but some people may find it easier to perform. The cough must be forceful and sustained i.e. a single cough will likely not be effective in terminating an arrhythmia

Cold Stimulus to the Face: (Mammalian dive reflex)This technique involves immersing the face in ice cold water. Alternative methods include placing on icepack on the face or a washcloth soaked in ice water. The cold stimuli to the face should last about 10 seconds. This type of vagal maneuver creates a physiological response similar to that which occurs if a person is submerged in cold water (diver’s reflex).

Head in sink:This is used more often in children than in adults.  Put swimming cap on, fill wash-house tub with cold water, immerse head and breathing through mouth, count to 10.  Goggles make it more enjoyable.  Try not to breathe.

Gagging: Although it may not sound pleasant, gagging also stimulates the vagus nerve and can stop an episode of SVT.  A tongue depressor is briefly inserted into the mouth, touching the back of the throat, which causes the person to reflexively gag. The gag reflex stimulates the vagus nerve.

Carotid Massage: Another type of vagal maneuver is carotid massage. This technique is performed with the patient’s neck in an extended position, with the head turned away from the side being massaged. Only one side should be massaged at a time. Find the neck pulse. Pressure is applied underneath the angle of the jaw in a gentle circular motion for about 10 seconds, moving up and down the neck. The patient should be monitored throughout. This technique may not be recommended for everyone. For example, patients who have carotid artery stenosis and a history of smoking may not be good candidates for the procedure. It has the risk of adverse outcomes in elderly patients.

Others

Rehydrate – drink lots of water

Drink icy cold drink through straw and keep going even through brain freeze.

Cold shower

Dive into cold water.

Breathe in deeply, expand chest and hold your breath for 10 seconds

For men: have sex – recommended by a male friend who had SVT until he underwent ablation.

Yawning

blowing up a balloon

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Just to let you all know, I had a successful ablation procedure a fortnight ago. I found the procedure itself to be quite easy. A little intimidating being wheeled into a full-on operating theatre at first but the doctors were very good and put me at ease. I only had 1mg of paracetamol and 5mg of fentanyl and was fully lucid throughout. I found it certainly less traumatic than having a tooth out at the dentist! Some bruising of the groin where the equipment went in but that's almost gone now. So far no recurrence of the SVT so fingers crossed, i'm cured!

?For anyone worried about having an ablation i'd say don't be. There's always going to be an element of risk with a procedure like this but honestly, like I said, I found it less traumatic than the dentist, and no mistake.

?Good luck, heres hoping for a good outcome for you all too!

I find that drinking four glasses of ice cold water usually helps was told this in Austria when I had a do there and was taken to their accident and emergency, hope this helps.

has anyone been advised to have a pacemaker by their cardiologist as I have. I have been told that all the flecanide can be upped on dose plus bisoprolol if I have a pacemaker. Bit worried as to what to do.

Well you would not believe it. Thank you Simon. This worked for me in 60 seconds the first time i tried it.

Great advice Simon, think the ice water works too. since placing my last contribution to this discussion I have had an ablation on 3rd JANUARY which has been successful so far thank goodness. I have not had one episode since and have been able to come off all my tablets after 18 years and feel that I have been given my life back, I am so grateful. I must admit though I never sleep on my left side, I suppose I have got so used to making sure I don't do this anymore and I don't want to tempt fate.

Regards Ursula x

good to hear your ablation went well Ursula.I will need to consider the same as i cannot tolerate the drugs.

How taxing was the ablation and recovery ?

thanks for your reply Ursula. i note that you had it done under GA. I live in Austalia and it appears to be done under LA. From what i know the op. takes a few hours and that would be difficult just under sedation. maybe i will have the GA option available.

Thanks again.

GEORGE.

hope so George, i had to go private, yes they do ablations with sedation but i just wanted to be away with the fairies whilst they did what was needed to be done.