Version July 2025
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What are vagal maneuvers? —
These are ways to change a person's heartbeat without using medicines. For some vagal maneuvers, a doctor presses on a certain part of your body. For others, they have you make a certain movement with your body.
Vagal maneuvers cause changes in your nervous system. Your nervous system then sends signals to your heart. These signals cause a response that affects your heartbeat.
Normally, a heartbeat happens when an electrical signal starts in a certain area in the heart. This signal follows a set path to spread across the heart. As it spreads, it causes the heart muscle to squeeze in a normal way and at a regular rate. This causes the heartbeat.
Vagal maneuvers slow down the electrical signals that start a heartbeat. They can also slow down the electrical signals that spread across the heart. Both of these things can slow down the heartbeat.
What are examples of vagal maneuvers? —
There are many different vagal maneuvers. The 2 doctors use most often are "carotid sinus massage" and the "Valsalva maneuver."
What does carotid sinus massage involve? —
To do carotid sinus massage:
●You will lie down.
●The doctor will press on a specific area in your neck called the "carotid sinus" for about 5 to 10 seconds. The carotid sinus lies under your skin in 1 of the carotid arteries (figure 1). The carotid arteries are the main blood vessels that bring blood to the brain.
●During the massage, the doctor will monitor your blood pressure. They will also do an electrocardiogram ("ECG") to monitor your heart activity (figure 2).
●The massage slows down your heartbeat and lowers your blood pressure. This can make you feel lightheaded or like you might pass out.
Doctors usually don't do carotid sinus massage in people who have certain medical conditions, including carotid artery disease. In carotid artery disease, fatty clumps called "plaques" build up in the carotid arteries.
What does the Valsalva maneuver involve? —
For the Valsalva maneuver:
●You might lie down on an exam table or bed. Your head and upper body will be partly raised.
●The doctor will have you breathe in and then try to breathe out hard, keeping your mouth and nose closed. This can feel like you are "bearing down" and trying to have a bowel movement.
●You will hold this position for up to 10 seconds. Then, you can breathe normally again.
●After holding your breath, the doctor might lower your head and upper body to flat. Then, they will have someone hold your legs up for 15 seconds.
●During the maneuver, the doctor will monitor your blood pressure. They will also do an ECG to monitor your heart activity (figure 2).
Why might my doctor use a vagal maneuver on me? —
Doctors commonly use vagal maneuvers to diagnose or treat certain heart problems. These can include:
●Different kinds of tachycardia – "Tachycardia" is when the heartbeat is faster than normal. Carotid sinus massage or the Valsalva maneuver can sometimes slow down or stop tachycardia, so the heart can beat normally again.
●Heart murmurs – The Valsalva maneuver is used in people who have a heart murmur. This is an extra sound doctors or nurses hear when they listen to the heart with a stethoscope. Your doctor or nurse might have you do the Valsalva maneuver when they listen to your heart. This will tell them more about your heart murmur.
●"Heart block" – In this condition, the electrical signals in the heart are slowed or stopped. Carotid sinus massage can help show your doctor where the block in your heart is.
●To find the cause of fainting – Doctors sometimes use these maneuvers to try to find out why a person fainted. Carotid sinus massage can show if the fainting is from a condition called "carotid sinus hypersensitivity."
Do doctors do other vagal maneuvers? —
In some situations, doctors use other maneuvers. For example, putting a person's face in a bowl of ice water can slow down the heartbeat. But this is not commonly done.
Can I do vagal maneuvers at home? —
It depends. If you have a condition that can cause a fast heartbeat, your doctor might teach you how to do the Valsalva maneuver on your own. This can help slow down your heartbeat.
If your doctor instructs you to try this on your own, make sure you follow all instructions carefully. If you continue to have symptoms, call your doctor or nurse.
Patient education: Carotid artery disease (The Basics)
Patient education: Tachycardia (The Basics)
Patient education: Heart murmurs (The Basics)
Patient education: Heart block in adults (The Basics)
Patient education: Heart block in children (The Basics)
Patient education: Syncope (fainting) (The Basics)
Patient education: Wolff-Parkinson-White syndrome (The Basics)
Patient education: Syncope (fainting) (Beyond the Basics)
Patient education: Wolff-Parkinson-White syndrome (Beyond the Basics)
