Master of Nursing, John Hunter Emergency Department, Australia.
Int Emerg Nurs. 2022 Sep;64:101201. doi: 10.1016/j.ienj.2022.101201. Epub 2022 Aug 23.
A 36 year old woman with chest pain and palpitations at 34 weeks gestation (gravidity 2, parity 1) presented to the emergency department where she was found to be in supraventricular tachycardia (SVT). This patient had an earlier episode of SVT during the same pregnancy that was managed with intravenous adenosine. During both presentations a REVERT trial style 'modified' Valsalva manoeuvre (including supine positioning with passive leg raise) was attempted without success. Acknowledging the potential for vena caval compression in pregnant patients while in the Trendelenburg position, the same manoeuvre was attempted with the novel additional of 45 degree left pelvic tilt. This 'modified' modified Valsalva was successful in restoring sinus rhythm, suggesting this technique may warrant further investigation as a viable treatment for pregnant patients with hemodynamically stable SVT.
一位 36 岁女性，妊娠 34 周时出现胸痛和心悸（孕次 2，产次 1），就诊于急诊，发现存在室上性心动过速（SVT）。该患者在同一妊娠期间曾出现过一次 SVT，当时采用静脉注射腺苷进行治疗。在两次发作中，均尝试了 REVERT 试验式“改良”瓦氏动作（包括仰卧位并被动抬高腿部），但均未成功。考虑到孕妇在Trendelenburg 体位时可能会发生腔静脉受压，因此尝试了相同的动作，并增加了 45 度左侧骨盆倾斜。这种“改良”的改良瓦氏动作成功恢复了窦性节律，表明该技术可能需要进一步研究，作为一种治疗血流动力学稳定的 SVT 孕妇的可行方法。
