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Randomised controlled trial
A modification to the Valsalva manoeuvre improves its effectiveness in treating supraventricular tachycardia
  1. Leszek Pstras
  1. Correspondence to : Leszek Pstras, Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, Warsaw 02-109, Poland; lpstras{at}

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Implications for practice and research

  • In patients with stable supraventricular tachycardia (SVT), a 15 s, 40 mm Hg Valsalva strain in the semirecumbent position should be followed by supine positioning and passive leg elevation immediately after the strain release (as long as it can be undertaken safely).

  • Research needs to be carried out on whether such a postural modification of the Valsalva manoeuvre (VM) is superior to the manoeuvre performed in the fully supine position.


One of the many applications of the VM is its use for arresting episodes of SVT based on the relatively sudden reduction of heart rate in response to the increased venous return …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.