Vagal tests for tachycardia, arrhythmia, extrasystole, SVC in adults. What is it, contraindications

Vagal tests are a technique for influencing the vagus nerve by provoking reflexes and irritating the nerve endings of other organs in order to normalize and restore heart function. A similar technique is used for tachycardia to reduce the heart rate.

In case of arrhythmia and extrasystole (disturbance in the rhythm of contraction of some parts and chambers of the heart), the use of vagal tests allows you to restore the heart rhythm. In the presence of SVC in an adult patient (Wolf–Parkinson–White syndrome), vagal tests help restore cardiac impulse and normalize heart function.

The technique of reflex stimulation of the vagus nerve generally has a positive effect on any organism and improves the patient’s overall well-being.

Advantages and disadvantages

Vagal tests for tachycardia, extrasystole and arrhythmia have undeniable advantages over other non-traditional methods:

• they can be used anywhere (many techniques of this method can be used at home, at work or on the street);
• the method of irritating the vagus nerve is not associated with the use of chemicals or drugs, and therefore does not affect the kidneys and stomach;
• suitable for people with allergies;
• the use of vagal methods does not cause harm to health;
• with the correct use of vagal test methods, heart function is completely normalized within a few minutes;
• The vagal test method can be used for patients of any age.
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However, vagal tests have disadvantages:

• the use of this method is impossible for heart pain, heart attack and stroke;
• vagal tests for tachycardia and arrhythmia can affect the body only in the absence of a strong stressful situation;
• if performed incorrectly, the technique will not give the desired effect and can harm the body;
• Performing vagal tests for a long period of time without a break can have a detrimental effect on the patient’s well-being, causing nausea, dizziness, and vomiting.

However, the effectiveness of vagal tests on the cardiovascular system and the body as a whole is very high, so this technique has been very popular over the last 20 years.

Diagnostic research methods

Symptoms of suspected arrhythmia need to be carefully checked. Alarming signs include not only rapid heartbeat, but also sudden cardiac arrest, pressure changes, weakness, alternating with drowsiness.

Many methods have been developed to diagnose arrhythmia. An electrocardiogram must be recorded - it can be short or long. Sometimes doctors provoke an arrhythmia to record readings and more accurately determine the source of the problem. Thus, diagnostics are divided into passive and active. Passive techniques include:

• Electrocardiography. Electrodes are attached to the patient's chest, arms and legs. The duration of the contraction phases of the heart muscle is studied and the intervals are recorded.
• Echocardiography. An ultrasonic sensor is used here. The doctor receives an image of the heart chambers, observes the movement of the valves and walls, and specifies their sizes.
• Daily ECG monitoring. This diagnosis is also called the Holter method. The patient carries a portable recorder with him at all times. This happens within 24 hours. Doctors receive information about heartbeats during sleep, rest and activity.

In some cases, passive research is not enough. Then doctors induce arrhythmia by artificial means. Several standard tests have been developed for this purpose. Here they are:

• exercise stress;
• mapping;
• electrophysiological study;
• Tilt table test.

Indications

Vagal tests are used in healthy people to determine the degree of their impact on the human body, and in sick patients to make an accurate diagnosis.

The use of the technique of active stimulation of the vagus nerve is also used:

• to relieve unpleasant symptoms of tachycardia (sinus and supraventricular) under the supervision of a doctor or by the patient independently;

• for diagnosing sinus insufficiency syndrome in patients over 60 years of age. In this case, patients may lose consciousness or experience severe dizziness when turning their heads, bending strongly, or wearing tight or tight clothing;
• to determine the type of tachycardia while simultaneously using ECG results;
• for arrhythmia, vagal tests are performed in cases of a sharp attack of supraventricular arrhythmia with a stable level of heart function and clear consciousness. Correct execution of a sequential chain of actions normalizes the heart rhythm, including during estrasystole;
• in the complex treatment of SVC in adults;
• for general strengthening of the heart and improving well-being.

Care

Most SVTs are more unpleasant than life-threatening, although very fast heartbeats can be problematic for people with an underlying medical condition. coronary heart disease or the elderly. Episodes require treatment when they occur, but interval therapy may also be used to prevent or reduce relapses. Although some treatments may apply to all SVTs, there are specific treatments available to treat some subtypes. Therefore, effective treatment requires knowledge of how and where the arrhythmia occurs and how it spreads.

SVT can be classified by whether the AV node is involved in rhythm maintenance. If so, slowing conduction through the AV node will stop it. Otherwise, AV node blocking maneuvers will not work, although temporary AV block is still useful because it can reveal the underlying abnormal rhythm.

Contraindications

There are cases when performing vagal tests is strictly prohibited.

These include:

• situations where rapid heartbeat is accompanied by pain in the chest or left arm;

  
  Pain in the sternum in the middle is a contraindication to vagal tests for tachycardia

• the patient has severe shortness of breath or cough, which can interfere with exercise;
• with severe weakness in the patient, a sharp drop in blood pressure or dizziness. In this case, any vagal tests can lead to loss of consciousness;
• if you experience convulsions, disturbances in movement or sensitivity in the limbs;
• during pregnancy;
• for arrhythmia, vagal tests are not performed in the case of acute coronary syndrome, signs of thromboembolism or pulmonary arrhythmia.

Any heart rhythm disturbance that is accompanied by similar symptoms may indicate the onset of complications of various types (stroke, pulmonary edema, heart attack). In this case, you must immediately stop any active actions and call an ambulance.

What examinations need to be completed

Any impact on the body if the patient is diagnosed with arrhythmia, tachycardia or any other abnormalities in the cardiovascular system can significantly affect the overall health, worsening it.

Unsystematic use of various methods of alternative medicine can provoke a series of attacks or the development of other diseases. Therefore, before influencing the vagus nerve by irritating the nerve endings of other organs and systems, it is recommended to undergo a general examination.

It includes:

• examination by a therapist, during which the specialist identifies the presence of disturbances in the heart rhythm and correlates them with the patient’s complaints;
• ECG of the heart, which can be taken at a clinic as prescribed by a doctor, or at any medical center, shows the presence of deviations from normal indicators of the cardiovascular system. Based on the results of the ECG, it is possible to clearly establish whether the patient has tachycardia, arrhythmia or SVC. The procedure is performed only in a calm state (a few minutes after climbing the stairs and in the absence of stress), otherwise the electrocardiogram readings may be incorrect. The cost of the procedure ranges from 600 to 1200 rubles.

• Blood and urine tests are performed to eliminate possible contraindications. A general blood test is necessary to establish whether the indicators correspond to the norm of hemoglobin, platelets and red blood cells. Based on its results, as well as a urine test, it is possible to determine the presence of inflammatory processes in the body or problems associated with blood clotting. You can get tested at a hospital clinic or medical laboratory. The price of a general urine test will be 350 rubles, and a blood test on average 600 rubles.
• Examination by a cardiologist is carried out only if there is an ECG done no later than 30 days before the date of admission. Based on the results of the analysis and listening to heart sounds, the cardiologist can make a preliminary diagnosis. And also provide advice on the possibility of performing vagal tests at home. If necessary, a cardiologist may prescribe an ultrasound to clarify the diagnosis.
• An ultrasound of the heart is performed to determine whether the condition of the heart and its individual parts corresponds to the patient’s age, and to exclude developmental anomalies and heart defects. Ultrasound examination allows you to determine the size of the heart chambers, the degree of blood ejection and determine the cause of arrhythmia or tachycardia in the patient. The study is carried out in a clinic or medical center and costs an average of 700 rubles.

After examination and diagnosis, the cardiologist in some cases prescribes an individual course of drug treatment. This appointment must be completed before or together with vagal tests.

Diagnostics

Diagnosis of pathology usually does not cause problems. Pathology can be identified by the characteristics characteristic of attacks. You just need to track your heart rate. With supraventricular tachycardia, for example, the number of heart contractions reaches 250 beats per minute. An ECG during an attack allows you to quickly identify pathology and make an accurate diagnosis. On the cardiogram, the doctor immediately detects a change in the shape and polarity of the P wave. If an ECG was not performed during the attack, daily monitoring is carried out. It allows you to register short episodes of tachycardia. Usually they are not felt by the patient himself.

To exclude organic pathology, additional studies are carried out such as:

1. MSCT of the heart.

1. Ultrasound of the heart.

1. MRI.

Procedure step by step

Vagal tests can be performed independently at home or in a hospital setting under the supervision of a physician. Depending on this, the method of carrying out the procedure differs.

In case of tachycardia, the main procedure for performing vagal tests can only be carried out by a doctor.

It consists of a neck massage and is carried out as follows:

• The patient lies on the couch flat on his back and his head is turned gently to the left.
• Then the doctor begins to massage the right side of the neck under the jaw. At the same time, an ECG is recorded and the heart rhythm is read.
• Massage of the carotid sinus is carried out with smooth circular movements for 7-10 minutes, depending on the patient’s condition.

• After which the patient’s head is turned to the right and the same neck massage is performed on the right.

Carrying out bilateral neck massage at the same time is not allowed due to the likelihood of reducing blood flow to the brain. Massage is performed only if there is no deterioration in the patient’s well-being.

Vagal tests for tachycardia can be performed independently at home using other methods:

Through influence on skin reflexes

The easiest way to influence is through cold massage of the skin.

• To do this, the patient needs to sit up straight and breathe deeply.
• Then the skin of the face should be wiped with 1-2 ice cubes for several minutes.
• After the procedure, the skin is wiped dry.

Another way to treat the skin involves immersing it in cold water:

• Add 10-15 ice cubes to a small bowl of cold water and wait 5 minutes. The water can be cooled in advance in the freezer compartment of the refrigerator or on the balcony in winter for 20 minutes. to a temperature of 5-7 °C.
• Then they hold their breath and immerse their face in a bowl of water for as long as possible. The optimal immersion time is 5-10 seconds. This should be done several times with 1 minute intervals to get the best result.
• After the procedure, you need to wipe your face dry and sit quietly for 5-10 minutes.

By influencing the gag reflex

• To do this, you need to take a clean teaspoon or tablespoon.
• Use the opposite end of the spoon to gently press on the root of the tongue until a gag reflex appears. It is not necessary to induce vomiting, but the gag reflex must be clearly expressed.
• Then you need to take a break of 20 seconds and repeat the procedure 3-4 times.

After 30-90 seconds after the procedure, there should be a significant improvement in overall well-being:

• your heart rate should drop significantly;
• the rhythm is completely restored to normal.

For arrhythmia, you can use basic vagal testing methods, which are recommended for patients with tachycardia. However, the following techniques are used more effectively in this case:

Irritation of the respiratory system

• The patient should sit or stand upright.
• Then, every 5 seconds, the patient should make 5-7 light coughs.
• After which, with a break of 10 seconds. all steps must be repeated. The entire procedure is performed 4-5 times until a slight sensation of excitement appears.

Valsava method

It is universal and is used for tachycardia and arrhythmia, including extrasystole.

This method is based on breathing with low pressure:

• The patient should sit down and stand up straight.
• Then the patient should slowly exhale all the air with effort.
• After that, you slowly inhale through your entire chest, also with effort, and hold your breath for 15 seconds.
• Next, the air is very slowly released from the lungs with great effort.
• All actions are repeated 3-5 times.

Breathing with internal pressure increases the activity of the cardiovascular system. The oxygen entering the bloodstream after holding the breath acts as a shock wave on the body, bringing the rhythm of the heart to a normal state.

Previously, methods of pressing on the eyeballs and the solar plexus area were used as vagal tests for arrhythmia. But due to the unsafe use of such exposure without appropriate training, these methods are currently not recommended for use at home.

In case of extrasystole, when interruptions in the functioning of the heart are associated with a certain state of the body, the following methods of irritating the vagus nerve can be used:

By holding your breath

• To do this, you need to sit and breathe for exactly a few minutes.
• Then, while inhaling, hold your breath for as long as possible and slowly exhale all the air completely. Then carefully inhale.
• The breath-hold must be repeated 3-5 times.

The Valsava method is actively used in the fight against interruptions in heart rhythm. Performing a set of exercises several times in a row reboots the entire body and restores heart rhythm without specialized treatment.

Known cases

After successful diagnosis and treatment, Bobby Julich finished third in the 1998 Tour de France and won a bronze medal in the 2004 Summer Olympics. Women's Olympic volleyball player Tayibah Hanif-Park underwent ablation for SVT just two months before competing in the 2008 Summer Olympics.[12]Tony Blair, former British Prime Minister, also had surgery for atrial flutter. Anastasia was diagnosed with the disease.[13] Olympic gold medal swimmers Rebecca Soni and Dana Vollmer both had heart surgery to correct SVT. Additionally, in early 2006, Neville Fields underwent corrective surgery for SVT. Wrestling manager. Paul Bearer's heart attack was attributed to SVT, resulting in his death.[14]Nathan Cohen, two-time world champion and New Zealand Olympic rowing champion, was diagnosed with SVT in 2013 when he was 27 years old.[15][16][ 17]. George Plimpton, renowned author, sportswriter and literary figure widely known for his writing, baseball fandom (he wrote the infamous April Fool's Day article about Sidd Finch, who could apparently hit 168 mph), and Disney Children's program of the Musterpes Theater channel, a heart attack was misdiagnosed, which was later determined to be a release of catacholamines, a form of SVT. Plimpton, a close friend of Robert Kennedy, was also credited along with Rafer Johnson and Rosie Greer in fighting Sirhan Sirhan's gun after he shot RFK at the Ambassador Hotel.

How long will the results last?

Vagal tests for tachycardia, arrhythmia and extrasystole can effectively influence the main symptoms of diseases expressed in mild form.

In this case, when an attack occurs, the use of the technique of irritating the vagus nerve through the effect on the nerve endings of the respiratory and digestive systems, as well as the nerve endings of the skin, quickly restores the heart rhythm, taming it down and normalizing the frequency and function of the heart.

After performing the exercises for a few minutes, the patient’s condition completely improves and the effect persists for several hours and even days in the absence of provoking factors.

Vagal tests are also actively used in the long-term treatment of tachycardia and arrhythmia as a way to combat attacks and measures for general strengthening of the heart. Systematic use of basic methods can significantly improve the condition of the cardiovascular system.

If health conditions deteriorate, including under the influence of unfavorable factors (physical activity, stressful situations, decreased immunity), an attack of arrhythmia, tachycardia and extrasystole may recur 2-3 hours after 1 attack.

To achieve long-term effects, patients are advised to maintain a healthy lifestyle and remain calm. It is the absence of stress that is the fundamental factor in the positive impact of reflex methods on the human body.

In the case of complex forms of heart disease, vagal tests may not always give the desired effect. Before using them, you should consult with a specialist and clarify the possibility of using this technique at home.

In any case, irritation of the vagus nerve during arrhythmia and tachycardia in complex stages can only be used as an addition to the drug course of treatment.

Treatment of paroxysmal supraventricular tachycardia

Treatment tactics are selected taking into account:

• forms of arrhythmia;

• its etiology;
• duration and frequency of attacks;
• presence of complications;
• general condition of the patient;
• concomitant diseases.

In some cases, urgent hospitalization of the patient is required. Planned hospitalization is carried out if the patient suffers more than 2 attacks per month. An in-depth examination is carried out in the hospital. Experts also determine appropriate treatment tactics and indications for surgical intervention.

To relieve paroxysm, vagal maneuvers are performed.

These include:

• straining;
• Valsalva maneuver;

• Aschner's test;
• Chermak-Goering test;
• wiping with cold water.

Such relief of an attack is not possible in all cases. Additionally, antiarrhythmic drugs are administered. For prolonged paroxysms that are not relieved by medications, electrical pulse therapy is performed. After the attack is over, patients are subject to constant monitoring by a cardiologist. It is he who determines how to treat the disease.

If attacks occur repeatedly, they should be warned.

For this purpose they prescribe:

1. Cardiac glycosides.

1. Beta blockers, etc.

Any of the drugs may or may not give the desired result. Therefore, their selection often takes a lot of time. Trial therapy begins with individual or combined administration of the above medications.

Surgical interventions are performed for:

• severe supraventricular tachycardia;
• ineffectiveness of measures aimed at preventing attacks.

The disease can be eliminated by:

1. Electrical, mechanical, laser, cryogenic or chemical destruction of additional impulse pathways or ectopic foci of automatism.

1. Radiofrequency amblation.

1. Implantation of pacemakers.

1. Implantation of electrical defibrillators.

Today, doctors pay special attention to techniques that ensure rapid recovery and are as safe as possible for the patient in terms of postoperative complications. The cardiologist will tell you about all intervention options. If necessary, he will refer you for a consultation with a cardiac surgeon.

Having been involved in treatment for many years, our specialists know exactly which technique to choose and will definitely take into account your wishes and individual characteristics. We do not inflate our prices for professional support. In our clinic in Moscow you can get help even with limited financial resources. The approximate price of consultation with specialists and examination is indicated on the website. Our specialist will determine the exact details at your appointment.

Possible complications

Methods of irritating the vagus nerve, such as putting the face in cold water and inducing reflexive vomiting, do not cause any consequences after use. Such methods can be used at any age several times a day without harm to health.

Breath-holding exercises should be performed when the patient has a high level of self-control over his own well-being. If you inhale sharply or hold your breath for a long time, the patient may lose consciousness, which can result in injury if they fall.

Actively performing breath-holding exercises can cause blockage of certain blood vessels in the brain and cause the development of other diseases. Therefore, you need to perform such exercises carefully. If you experience discomfort or deterioration in your health, it is better to refuse vagal tests and consult a doctor.

The carotid sinus massage method, when performed at home by a person without appropriate education, can lead to serious health complications:

• cause a strong outflow of blood from the brain with the onset of oxygen starvation;
• cause damage to the spine and neck muscles;
• cause swelling and damage to the soft tissues of the neck;
• increase pressure.

Vagal tests in general are not recommended in case of a sharp deterioration in general health in patients with tachycardia or arrhythmia. Active use of this technique at the stage of relapse of severe attacks of arrhythmia, tachycardia without completing the necessary course of drug treatment can lead to heart attack, stroke and the development of vascular thrombosis.

The risk of developing adverse effects increases sharply in older people or those suffering from other chronic diseases (diabetes mellitus, thrombophlebitis).

However, after consulting with a doctor and undergoing a course of treatment, eliminating the main contraindications, the method of influencing the vagus nerve when performed at home can give excellent results and gradually improve the entire cardiovascular system.

Article design: Vladimir the Great

Recommendations

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   “Types of arrhythmia.”
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   Al-Zaiti, SS;
   Magdik, K.S. (September 2021). "Paroxysmal supraventricular tachycardia: pathophysiology, diagnosis and treatment." Intensive Care Clinics of North America
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   “How to Treat the 2008 USA Volleyball Olympics AriPress Kit” (PDF). USAvolleyball.org. Retrieved 2013-11-02.
6. "Anastacia is postponing heart surgery." World News. November 3, 2008. In the archive from the original dated March 14, 2012. Retrieved April 30, 2010.
7. "Paul Bearer's cause of death was heart attack." TMZ.com. 2013-03-23. Archived from the original 2013-11-02. Retrieved 2013-11-02.
8. Ian Anderson (27 August 2013). "Rowing | Bad day for New Zealand crews." stuff.co.nz. Retrieved October 30, 2013.
9. “Heart problems push Olympic champion out of world champions.” Radio New Zealand. August 26, 2013. Archived from the original November 2, 2013. Retrieved October 30, 2013.
10. "Heart Disease Takes Cohen Out of World Rowing Championships." TVNZ. August 26, 2013. Archived from the original on November 1, 2013. Retrieved October 30, 2013. Scott Brady of the punk band Brave The Wild (“Archived copy.” Archived from the original on 2017-09-08. Retrieved 2014- 04-17.CS1 maint: archived copy as header (link)) suffers from this. He had his first attack on April 9, 2012, while playing golf, and was hospitalized overnight. He was diagnosed on April 17, 2014, in Hamilton, Washington, after having a seizure while walking home after dinner on March 16, 2014.