Exploring the effectiveness of modified Valsalva maneuver in terminating supraventricular tachycardia after myocardial revascularization: A double-trouble case report

Supraventricular tachycardia (SVT) is a common arrhythmia typically managed with pharmacological treatments. However, managing SVT in post-myocardial revascularization patients presents unique challenges, including the potential for arrhythmias and hemodynamic instability. Although the Modified Valsalva maneuver (MVM) is effective in the general population, its use in post-revascularization patients remains underexplored. The aim of this case report was to describe the case of a patient who experienced a second episode of SVT following myocardial revascularization and successfully reverted to sinus rhythm using MVM. A 38-year-old male with a history of myocardial revascularization presented to the emergency room with chest pain, palpitations, and shortness of breath. A week prior, the patient had undergone percutaneous coronary intervention. Following diagnosis of stable SVT and MVM was performed. The patient was positioned in the semi-Fowler's position and instructed to blow into a 20 mL syringe for 15 seconds to increase intrathoracic pressure. Following this, the patient was repositioned supine, and the legs were passively elevated for 15 seconds then subsequently returned to the semi-Fowler's position for reassessment of the cardiac rhythm. After the maneuver, the SVT rhythm on the monitor was successfully converted to sinus tachycardia at a rate of 106 beats per minute. This case highlights that MVM could be a promising non-invasive option for managing SVT in post-myocardial revascularization patients. Although further research is needed to establish clear guidelines, this case highlights the utility of MVM in complex clinical scenarios.