What Is the Valsalva Maneuver?

Medically Reviewed by James Beckerman, MD, FACC on February 06, 2023
Written by Mary Jo DiLonardo
3 min read

The Valsalva maneuver is one of several simple physical actions called vagal maneuvers that act on the vagus nerve to slow your heart rate. Doctors may suggest vagal maneuvers to try and slow your heart when it’s beating too fast. 

To do the Valsalva maneuver, you take a big breath and hold it in by closing your windpipe at the throat with your glottis – as when you start to cough – and then pushing with your belly area as if you were straining for a bowel movement. 

Your doctor may suggest the Valsalva maneuver if you have supraventricular tachycardia, or SVT. This is a problem with your heart’s electrical signals that causes it to beat too fast. It isn’t usually serious unless you have other heart problems.

Your doctor will tell you to:

  • Sit down or lie down.
  • Take a deep breath and hold it by closing your throat.
  • Bear down hard, as if you’re trying to go to the bathroom.
  • Strain hard for about 10 to 15 seconds.
  • Release the air when you’re done.
  • Wait at least a minute before you try again.

It relaxes your heart’s electrical system. This happens in four phases:

  • Phase One: When you start pushing, pressure rises in your chest and belly. That forces blood out of your heart and down your arms. This causes your blood pressure to go up for a short time.
  • Phase Two: Your heart pumps less blood with each beat while you’re straining. Your blood pressure steadily returns to normal.
  • Phase Three: When you relax at the end of this maneuver, your heart rate increases.
  • Phase Four: This is the recovery period. Blood rushes back to your heart. Ideally, your blood pressure rises but then returns to baseline as your heart rate goes back to normal.

It’s best to talk to your doctor before trying the Valsalva maneuver. Away from the hospital, if the maneuver doesn’t slow your racing heart after about 20 minutes, call the doctor. You might need to go to the emergency room for treatment.

If you have a fast heart and any of the following symptoms, call 911 or get to the ER right away:

  • Pain in your chest, upper back, arms, neck, or shoulder
  • Shortness of breath
  • Lightheadedness
  • Fainting
  • Weakness

Go to the ER instead of a clinic or your doctor’s office. They’ll be able to give you the help you need.

If you have heart disease, don’t use the Valsalva maneuver unless your doctor tells you to. It’s rare, but the technique could cause chest pain and other heartbeat problems.

Sometimes the maneuver causes a rise in pressure behind the eyes. Don’t use it if you have retinopathy -- damage to the retina in the eye -- or have an implanted lens.

Side effects are rare, but talk to your doctor if you have concerns or questions about how to perform it correctly.

  • Cough. You need to cough hard to generate pressure in your chest and stimulate the vagus nerve. Children with tachycardia may not be able to cough hard enough to get a response from the vagus nerve.
  • Gag.  You can try it with a finger. Your doctor might use a tongue depressor.
  • Hold your knees against your chest: Do it for a minute. This may work best for babies and children.
  • Cold water treatment. Your doctor might call this the diving reflex. You may need to put a plastic bag of ice on your face for 15 seconds. Or you can immerse your face in icy cold water for several seconds. It might also work to step into a cold shower or a cold bath.
  • Carotid sinus massage. Only a doctor should perform this one. Lie down and stick out your chin. The doctor will put pressure on your carotid sinus, a bundle of nerves surrounding the carotid artery in your neck just below your jaw. You’ll be monitored during the procedure.