Mohd Firdaus Bin Mohd Yahaya



MF Yahya1, S Dzulkornain1, MH Mohd Azam1, SA Baharin1, N Mohamad Amin1, N Abdullah1

1 Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia



Supraventricular tachycardia (SVT) in children is  medical emergency. The fast heart rate can  be controlled with drugs or manually using carotid massage or valsalve manoeuvre. The use of drug like adenosine may cause side effects. Modified postural vasalva manoeuvre to control heart rate is more effective (43%)  in comparison to the standard manoeuvre (17%).

Case Report

A 12 years old boy came for abrupt onset of palpation, giddiness, and chest discomfort. He had history of previous SVT but had no congenital heart disease. Blood  pressure was 130/70 mmHg,  pulse was 200/ min. ECG showed supraventicular tachycardia. Postural modified vasalva was performed with consent where patient was position and asked to blow against 10cc syringe with the plunger in   followed by immediately lifting up both legs to ninety degree in supine position for 15 seconds.  Cardiac monitor showed the SVT resolved following the procedure.


SVT occurs in about 0.1–0.4%  of healthy children. Treatment with adenosine may cause unwanted side effects. Postural Modified Valsava method is safe, simple, cost effective and can  easily be applied to school age children. The strain was produced when the plunger of 10cc syringe moved with blowing (equal to 40mmHg) to create vagal reflex together with passive legs raising to stimulate vagal tone and baroreflex.


In patients with stable SVT, a modified valsalva maneuver should be attempted to convert SVT as it is simple, zero cost, well tolerated without serious adverse events.













































Supraventricular tachycardia, paediatric, postural modified valsava

1. Morley - Smith EJ, et al ; Cardioversion of a supraventricular tachycardia (SVT) in a 7-year-old using a postural modification of the Valsalva manoeuvre;BMJ case report 2017. Doi:10.1136/bcr – 2016 -218083
2. Clausen H, Theophilos T, Jackno K, et al. Paediatric arrhythmias in the emergency department. Emerg Med J 2012;29:732–7.
3. Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015;386:1747–53.
4. Spearman AD, Williams P. Supraventricular tachycardia in infancy and childhood. Pediatr Ann 2014;43:456–60.
EMAS Meeting 2018 Abtracts