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Vagal techniques

These techniques stimulate your vagus nerve, which can slow a fast heart rate. Practise them when you are well so you are confident during an episode.

1. Valsalva manoeuvre

Bear down for 10–15 seconds

  1. Sit down and lean slightly forward.
  2. Take a deep breath in.
  3. Close your mouth, pinch your nose, and bear down hard — as though straining on the toilet.
  4. Hold for 10–15 seconds (use the timer below).
  5. Release suddenly and breathe normally. Lie flat with legs raised if possible.
  6. Wait 30 seconds. If the fast rate continues, repeat up to 3 times.
15
Safety: Do NOT use this technique if you have: glaucoma, retinal detachment, or other eye conditions; significant valve disease (especially aortic stenosis); a recent stroke; carotid artery disease; uncontrolled high blood pressure; or are pregnant. If you feel faint, stop immediately and lie down.

2. Cold water dive reflex

Cold water on the face for 10–20 seconds

  1. Fill a bowl with cold water and ice if available.
  2. Take a deep breath in and hold it.
  3. Submerge your face (forehead, eyes, cheeks) in the cold water.
  4. Hold for 10–20 seconds (use the timer below).
  5. Lift your face out and breathe normally.
20

Alternative: If you cannot submerge your face, hold a flannel soaked in ice-cold water firmly across your forehead and cheeks for the same duration.

Safety: Do not use if you have Raynaud's disease, severe circulation problems, cold urticaria, autonomic neuropathy (e.g. from diabetes), or a history of fainting. Always sit down and have someone nearby, especially the first few times.

3. 4–6 Breathing

Slow breathing to activate the vagus nerve

  1. Sit or lie comfortably.
  2. Breathe in gently through your nose for 4 seconds.
  3. Breathe out slowly through your mouth for 6 seconds.
  4. Repeat for 5 minutes (about 6 breaths per minute).
Ready

The circle expands as you inhale and contracts as you exhale. Learn more in the full programme.

When you finish, your nervous system has received the signal. You can close this page and return to whatever you were doing.

When to use: the 5-step protocol

  1. Recognise: You feel your heart racing or fluttering.
  2. Record: Take a Kardia recording immediately.
  3. Breathe: Start 4–6 breathing for 2 minutes.
  4. Try a manoeuvre: If still racing, try the Valsalva or cold water technique.
  5. Seek help: If it does not stop after 15 minutes, or you feel unwell, call 111 or go to A&E.

Related reading

The 4-6 Breathing Technique

Five minutes, twice a day. The evidence says your heart rhythm can change within a single session.

The OpenPalp programme

Email [email protected] to book your free clinic appointment — Tuesday mornings at the SF Studios, Hampstead. Optional 12-lead ECG (£49) and one-week home rhythm monitoring (£70) are available.

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