What Is the Valsalva Maneuver?

The Valsalva maneuver is a breathing method that may slow your heart when it’s beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm.

In some cases, doctors also use the maneuver to test how well your heart is working. You might already use a version of it to help make your ears “pop” because of air pressure, like when flying on a plane.

When to Do the Valsalva Maneuver

Your doctor will probably suggest the Valsalva maneuver if you have a type of fast heart rate called supraventricular tachycardia. This is a problem with your heart’s electrical signals. It isn’t usually serious, unless you have other heart problems.

How to Do the Valsalva Maneuver

Your doctor will tell you to:

  • Sit down or lie down.
  • Take a deep breath and hold it.
  • Pinch your nose shut.
  • Close your mouth.
  • Bear down hard, as if you’re trying to go to the bathroom.
  • While you’re bearing down, breathe out like you’re trying to blow up a balloon.
  • Strain hard for about 10 to 15 seconds.
  • If it doesn’t work, wait for at least a minute before you try again.

What Does the Valsalva Maneuver Do?

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

  • Phase One: When you start blowing, 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.

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What to Do Afterward

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.

Potential Risks

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.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on January 10, 2020

Sources

SOURCES:

Heart and Lung: “The Valsalva maneuver: mechanisms and clinical implications.”

Mayo Clinic Proceedings: “The Valsalva Maneuver—3 Centuries Later.”

StatPearls: “Valsalva Maneuver.”

Mayo Clinic: “Airplane ear,” “Supraventricular tachycardia.”

Johns Hopkins Medicine: “Supraventricular Tachycardia (SVT).”

Vanderbilt University Medical Center: “Valsalva Maneuver.”

Canadian Journal of Anesthesia: “Intraoperative Valsalva maneuver: a narrative review.”

Harvard Health Publishing: “Skipping a beat -- the surprise of heart palpitations.”

American Heart Association: “Tachycardia: Fast Heart Rate.”

UpToDate: “Vagal maneuvers.”

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