It can be a terrifying feeling. Your heart suddenly starts racing, hammering away in your chest like it’s trying to escape. It’s not from running a race or being scared—it just… starts. In these moments, when your heart rhythm goes off-track, your doctor might suggest something that sounds a little strange: the Valsalva maneuver. It’s a simple, non-invasive breathing technique that we often try first to help your heart get back to its normal, steady beat. It might seem odd, but this little trick can be surprisingly powerful.
What Exactly Is the Valsalva Maneuver?
At its core, the Valsalva maneuver is a specific way of breathing that involves trying to exhale forcefully while your mouth is closed and you’re pinching your nose shut. Think about the strain you feel when you’re having a bowel movement or lifting something very heavy—that’s the basic idea.
This action creates a cascade of changes in your body’s pressure, which in turn affects your heart. We most often use it to try and stop a specific type of fast heart rhythm called supraventricular tachycardia (SVT). This is just a medical term for when the upper chambers of your heart decide to start beating incredibly fast, out of the blue.
But it’s not just for treatment. We can also use this maneuver as a diagnostic tool to:
- Help figure out the type of heart murmur someone has.
- Get clues about potential heart failure.
- Diagnose issues with veins, like a varicocele (a swollen vein in the scrotum).
- Assess the autonomic nervous system, which is the “automatic” system that controls things like your heartbeat and breathing without you thinking about it.
How to Perform the Maneuver
It’s crucial that you only do this after a doctor has shown you how and confirmed it’s safe for you. We need to be sure your specific heart rhythm is the kind that might respond to this.
Here’s a breakdown of how it’s typically done in a clinical setting.
| Step | Action |
|---|---|
| 1. Get in Position | Lie down on your back or sit comfortably. |
| 2. Take a Breath | Take a normal, deep breath in. |
| 3. Strain | Close your mouth, pinch your nose, and bear down as if you’re trying to have a bowel movement. We might ask you to blow into a pressure-measuring device to ensure you’re straining hard enough (to about 40 mm Hg). Hold this strain for about 15-20 seconds. |
| 4. Release | Let go, open your mouth/nose, and breathe out normally. |
| Modified Version | For SVT, we often use a modified Valsalva maneuver. Immediately after you stop straining (Step 4), we will quickly raise your legs up to a 45-degree angle. This simple change helps more blood return to the heart and has been shown to be much more effective. |
What’s Happening Inside Your Body?
It feels like a simple action, but it sets off a complex four-phase chain reaction in your cardiovascular system.
| Phase | What You’re Doing | What Your Body Does |
|---|---|---|
| Phase 1 | Beginning to strain | The pressure in your chest spikes, briefly pushing your blood pressure up. |
| Phase 2 | Holding the strain | Less blood returns to the heart. Your blood pressure drops, and your heart rate speeds up to compensate. |
| Phase 3 | Releasing the strain | Your blood pressure dips for a moment as the pressure in your chest normalizes. |
| Phase 4 | Recovering | Blood rushes back to your heart. Blood pressure overshoots, going higher than normal, which triggers your body to dramatically slow your heart rate down. This is the “reset” that can stop an SVT. |
Is It Always Safe?
For most people, yes, it’s very safe. But it’s not for everyone. Because it increases pressure in your eyes and abdomen, we would tell you to avoid it if you have:
- Retinopathy (an issue with the blood vessels in your eye’s retina).
- Intraocular lens implants, for instance, after cataract surgery.
We also need to be cautious and weigh the pros and cons if you have a history of heart valve disease, coronary artery disease, or congenital heart disease.
The big advantage is that it’s a quick, drug-free way to potentially fix a scary heart rhythm. If it works, you can avoid a trip to the emergency room, medications, or even electrical cardioversion.
Side effects are uncommon, but can include temporary chest pain, feeling faint, or other changes in heart rhythm. A stroke is a very rare but serious risk. This is why it’s so important to learn it from a professional first.
If it’s successful, your heart rate should return to normal within a minute. But it doesn’t always work—the success rate is somewhere between 5% and 20% for the standard method. If after a few tries it doesn’t work, don’t panic. That just means we move on to the next step in our treatment plan, which could be medications or other procedures. We’ll be right there with you.
Take-Home Message
- The Valsalva maneuver is a breathing technique where you try to exhale forcefully against a closed airway (like straining).
- It’s primarily used as a first-line, non-drug treatment for a fast heart rhythm called supraventricular tachycardia (SVT).
- Always learn how to perform it from a healthcare provider. Do not try it for the first time on your own if you think you’re having heart issues.
- The modified version, where your legs are lifted after straining, is often more effective at stopping SVT.
- If it doesn’t work, that’s okay. It’s just one tool in our toolbox, and your doctor will have a clear plan for what to do next.
Feeling your heart race is unsettling, I know. But remember, we have safe and effective ways to manage it. You’re not alone in this.