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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
Supraventricular tachycardias can be terminated by vagal maneuvers such as carotid sinus massage, splashing the face with cold water, or a Valsalva maneuver. If these vagal maneuvers are unsuccessful, intravenous adenosine or verapamil should be tried. Electrical cardioversion has been used successfully during pregnancy for reversion to sinus rhythm (108).
Arrhythmias in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Dana Senderoff Berger, Lee Brian Padove
If hemodynamically unstable, electrical cardioversion is the treatment of choice. For stable patients, first line intervention is vagal maneuvers, followed quickly if necessary by adenosine IV 6–12 mg [30]. If adenosine is ineffective, the patient's history suggests she has been going in and out of the arrhythmia that day, or there is clinical suspicion of hyperthyroidism, intravenous beta-blocker (metoprolol 5 mg or propranolol 1 mg) may be used. If these fail, intravenous procainamide or verapamil may be used [24]. However, as previously stated, verapamil should be avoided if possible due to potential for hypotension and fetal hypoperfusion. Aside from avoidance of verapamil, this management strategy is similar to the nonpregnant patient. The European Society of Cardiology recommends beta-blocker or verapamil for preventive therapy in this group [30]. If maternal blood pressure is marginal or relatively low, digoxin is safe and can be used as first line. Dosing with digoxin usually is twice a day during pregnancy and at higher doses than usual while following therapeutic effects and levels. (See Figure 16.3.)
Idiopathic Ventricular Tachycardia
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Jackson J. Liang, David S. Frankel
Decreasing intracellular cAMP results in inhibition of arrhythmia. Adenosine, beta blockers, calcium channel blockers, acetylcholine, vagal maneuvers (carotid sinus massage, Valsalva).
Etripamil nasal spray: an investigational agent for the rapid termination of paroxysmal supraventricular tachycardia (SVT)
Published in Expert Opinion on Investigational Drugs, 2020
Anthony H. Kashou, Peter A. Noseworthy
Management algorithms and guidelines exist for paroxysmal SVT [3]. Vagal maneuvers (e.g. Valsalva and carotid sinus massage) and/or intravenous adenosine are often first-line interventions to terminate the SVT by blocking or slowing AV nodal conduction. If these are ineffective or not feasible, immediate synchronized cardioversion should be performed in hemodynamically unstable patients – however, this uncommonly needed. In hemodynamically stable patients, intravenous medications (beta blockers or calcium-channel blockers) can be administered. If intravenous drug therapy is ineffective, not tolerated, or not feasible, synchronized cardioversion may be performed. When patients are unable to tolerate or are refractory to drug therapy, catheter ablation remains the mainstay of treatment. However, we do stress that a single episode of SVT is not considered an indication for ablation since recurrence rates vary considerably and some patients may become asymptomatic over time [4].
Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature
Published in International Journal of Neuroscience, 2018
Sanjeet S. Grewal, Andrea C. Adams, Jamie J. Van Gompel
The relationship between the vagal nerve and hiccups is not a novel, recent discovery. Historically, multiple techniques that manipulate vagal nerve activity have been used to abort episodes of hiccups. These include the Dagnini–Aschner maneuver, carotid sinus massage, the Valsalva maneuver, stimulation of the auditory canal and the induction of emesis [24]. The induction of emesis specifically dates back to Galen, where he states, ‘[a] hiccup may be occasioned by some acrimonious or ferrous humors, or some medicine vellicating the stomach, which being expelled by vomiting, the hiccup immediately ceases’ [24]. This vagal maneuver was the only thing that actually benefitted the patient in this case, although the effects were transient. In light of this, combined with him failing all other therapies, we proceeded with vagal nerve stimulation.
Supraventricular tachycardia with the use of phentermine: case report and review of literature
Published in Postgraduate Medicine, 2021
Sundeep Kumar, Akhil Mogalapalli, Ruthvik Srinivasamurthy, Sayed T. Hussain, Philip L. Mar
Chronic therapy for AVNRT depends on symptom burden, severity of disease, and patient’s preference. For patients who do not have frequent episodes, vagal maneuvers can be used to terminate recurrent episodes as needed. For patients with frequent episodes, chronic medical therapy can be used for prevention. Beta blockers and nondihydropyridine calcium channel blockers are the first line of medical therapy. In rare instances, for patients who are unable to tolerate these medications and unwilling to undergo catheter ablation antiarrhythmic drugs may be considered. However, given the toxicities of antiarrhythmic agents, they are only used in rare cases after evaluation by a cardiac electrophysiologist [21].