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Vagal maneuvers

Daniel R Frisch, MD
Peter J Zimetbaum, MD
Section Editor
Brian Olshansky, MD
Deputy Editor
Brian C Downey, MD, FACC


The autonomic nervous system is composed of the sympathetic and parasympathetic divisions. This system innervates and regulates most visceral functions including electrophysiological and hemodynamic cardiovascular responses.

Various physical maneuvers can elicit autonomic responses. Many of these maneuvers can be performed at the bedside or in an office setting with minimal risk. These maneuvers can be both diagnostic (eg, in confirming carotid sinus hypersensitivity) and therapeutic (eg, terminating paroxysmal supraventricular tachycardia). Understanding the indications, techniques, and complications of various vagal maneuvers is necessary to safe and effective clinical application.

A wide variety of physical maneuvers can have intended or unintended influence on increasing vagal tone. These include:

Carotid sinus massage (see 'Carotid sinus massage' below)

Valsalva maneuver (standard or modified technique) (see 'Valsalva maneuver' below)

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Literature review current through: Sep 2017. | This topic last updated: Aug 02, 2017.
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