Hillary's VALSALVA maneuver

[Raya @ REAL CONSERVATIVES]

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A classic Valsalva Maneuver:

( caught on camera )

The Valsalva maneuver should be the first vagal maneuver tried and works by increasing intra-thoracic pressure and affecting (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold his/her breath while trying to exhale forcibly as if straining during a bowel movement. Holding the nose and exhaling against the obstruction has a similar effect.

OBSERVE CLOSELY

She is performing the maneuver in this episode:

NORMAL SINUS RYTHM ACHIEVED,

SHE "KEEPS ON TALKING"

May have been injected with

Adenosine, an ultra-short-acting

AV nodal blocking agent

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Supraventricular tachycardia (SVT) is an abnormal heart rhythm arising from improper electrical activity of the heart. It is a type of rapid heart rhythm originating at or above the atrioventricular node. It can be contrasted with the potentially more dangerous ventricular tachycardias—rapid rhythms that originate within the ventricular tissue.

Although SVT can be due to any supraventricular cause, the term usually refers to a specific example, paroxysmal supraventricular tachycardia (PSVT), two common types being atrioventricular reentrant tachycardia and AV nodal reentrant tachycardia. In the older population atrial fibrillation becomes a common type of supraventricular arrhythmias—though it is typically considered separately.

In general, SVT is caused by one of two mechanisms: re-entry and automaticity. Re-entry (such as AV nodal reentrant tachycardia and atrioventricular reciprocating tachycardia) often presents with an almost immediate increase in heart rate.^[2] Someone experiencing this type of PSVT may feel the heart rate accelerate from 60 to 200 beats per minute or more. Typically, it reverts to normal just as suddenly.

In "automaticity" types of SVT (atrial tachycardia, junctional ectopic tachycardia), there is more typically a gradual increase and decrease in the heart rate. These are due to an area in the heart that generates its own electrical signal.

Signs and symptoms

Signs and symptoms can arise suddenly and may resolve without treatment. Stress, exercise, and emotion can all result in a normal or physiological increase in heart rate, but can also, more rarely, precipitate SVT. Episodes can last from a few minutes to one or two days, sometimes persisting until treated. The rapid heart rate reduces the opportunity for the "pump" to fill between beats decreasing cardiac output and as a consequence blood pressure. The following symptoms are typical with a rate of 150–270 or more beats per minute:

• Pounding heart
• Shortness of breath
• Chest pain
• Rapid breathing
• Dizziness
• Loss of consciousness  " SYNCOPE*** , fainting, falling "  (in only the most serious cases)

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***Vasovagal Syncope:

Main article: Vasovagal syncope

Vasovagal (situational) syncope is one of the most common types which may occur in response to any of a variety of triggers, such as scary, embarrassing or uneasy situations, during blood drawing, or moments of sudden unusually high stress. There are many different syncope syndromes which all fall under the umbrella of vasovagal syncope related by the same central mechanism, such as urination ("micturition syncope"), defecation ("defecation syncope"), and others related to trauma and stress.

Vasovagal syncope can be considered in two forms:

• Isolated episodes of loss of consciousness, unheralded by any warning symptoms for more than a few moments. These tend to occur in the adolescent age group, and may be associated with fasting, exercise, abdominal straining, or circumstances promoting vaso-dilation (e.g., heat, alcohol). The subject is invariably upright. The tilt-table test, if performed, is generally negative.
• Recurrent syncope with complex associated symptoms. This is neurally mediated syncope (NMS). It is associated with any of the following: preceding or succeeding sleepiness, preceding visual disturbance ("spots before the eyes"), sweating, lightheadedness. The subject is usually but not always upright. The tilt-table test, if performed, is generally positive. It is relatively uncommon.

A pattern of background factors contributes to the attacks. There is typically an unsuspected relatively low blood volume, for instance, from taking a low-salt diet in the absence of any salt-retaining tendency. Heat causes vaso-dilation and worsens the effect of the relatively insufficient blood volume. That sets the scene, but the next stage is the adrenergic response. If there is underlying fear or anxiety (e.g., social circumstances), or acute fear (e.g., acute threat, needle phobia), the vaso-motor centre demands an increased pumping action by the heart (flight or fight response). This is set in motion via the adrenergic (sympathetic) outflow from the brain, but the heart is unable to meet requirement because of the low blood volume, or decreased return. The high (ineffective) sympathetic activity is always modulated by vagal outflow, in these cases leading to excessive slowing of heart rate. The abnormality lies in this excessive vagal response. The tilt-table test typically evokes the attack.

Much of this pathway was discovered in animal experiments by Bezold (Vienna) in the 1860s. In animals, it may represent a defence mechanism when confronted by danger ("playing possum").

Avoiding what brings on the syncope and possibly greater salt intake is often all that is needed.

Psychological factors also have been found to mediate syncope. It is important for general practitioners and the psychologist in their primary care team to work closely together, and to help patients identify how they might be avoiding activities of daily living due to anticipatory anxiety in relation to a possible faint and the feared physical damage it may cause. Fainting in response to a blood stimulus, needle or a dead body are common and patients can quickly develop safety behaviours to avoid any recurrences of a fainting response. See link for a good description of psychological interventions and theories.

An evolutionary psychology view is that some forms of fainting are non-verbal signals that developed in response to increased inter-group aggression during the paleolithic. A non-combatant who has fainted signals that she or he is not a threat. This would explain the association between fainting and stimuli such as bloodletting and injuries seen in blood-injection-injury type phobias such as trypanophobia as well as the gender differences.

For infants and toddlers, symptoms of heart arrhythmias such as SVT are more difficult to assess because of limited ability to communicate. Caregivers should watch for lack of interest in feeding, shallow breathing, and lethargy. These symptoms may be subtle and may be accompanied by vomiting and/or a decrease in responsiveness.^[3]

CLICK HERE:

http://tpartyus2010.ning.com/profiles/blogs/swirling-away-in-questi...

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