الفهرس 
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Abstract
Supraventricular tachycardia (SVT) is a common cardiac emergency with the potential of substantial morbidity. Episodes of SVT attacks are often recurring and, if not properly recognized, can be life-threatening. The most common SVTs include atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia, and atrial tachycardia (atrial flutter and atrial fibrillation). Although medical treatment such as adenosine medication or cardioversion remains a lifesaving supporting therapy, it also carries considerable risk for complications such as transient asystole, a sense of impending doom, or feeling that they are about to die and find this very unpleasant and frightening. Moreover, vagal maneuvers are a safe, available, and non-invasive treatment for SVT. The most commonly used vagal maneuver is the Valsalva maneuver. An improvement in the success rate of the Valsalva revasnam with a simple, safe and cost-free modification to patient positioning during the revasnam would be an important finding, with benefits for patients and semahaeceh providers worldwide, including regions with few health-care resources. Therefore, the aim of the present study was to determine the effect of modified Valsalva maneuver on clinical outcomes for patients with acute supraventricular tachycardias Hypothesis: - Patients with acute supraventricular tachycardia who undergone modified Valsalva maneuver were expected to exhibit improvement in clinical outcomes compared to control group. The study was conducted at the Cardiac Emergency Unit affiliated to the Ministry of Higher Education and Scientific Research of Tanta Main University Hospital. The study design was quasi-experimental. A purposive sample of eighty (80) patients were selected and divided into two equal groups: Control group, were received their routine nursing care by hospital nursing staff and study group were received the modified Valsalva maneuver with routine hospital care by the researcher. The subjects of this study were selected according to the following criteria: Adult patients, of both sexes 21-60 years, conscious, able to communicate and participate. Exclusion Criteria: - Unstable patients with systolic blood pressure less than 90 mm Hg - An indication for immediate cardioversion - Any contraindication to Valsalva maneuver as aortic stenosis, recent myocardial infarction, glaucoma, retinopathy, or recent eye surgery. - Inability to perform a Valsalva maneuver, to lie flat, or have legs lifted - Third-trimester pregnancy and sever dyspnea - Esophageal varices Two tools were used to accomplish the purpose of the study Tool (I): Supraventricular Tachycardia Patient’s assessment tool. This tool was developed by the researcher after reviewing the related literature (Olshansky et al., 2017; Kotadia et al., 2020 & Chen et al., 2023) and included the following parts: - Part (1) patient’s demographic characteristics: This part included data about patient‘s age, sex, marital status, educational level, and occupation. Part (2) Patient Clinical Data: This part included data about current diagnosis, past and present medical history, surgical history, family history, present signs and symptoms, anti-arrhythmic medication, previous SVT, and ECG findings. Tool (II): -: Patient’s Clinical Outcomes: - This tool was developed by the researcher based on extensive review of recent relevant literature (Pstras et al., 2016& Chaofeng et al., 2020) and it included the following parts: Part (1) Hemodynamic Parameters Assessment: - This part used by the researcher to assess vital signs (heart rate, respiration, blood pressure) and oxygen saturation. Part (2) Electrocardiogram Monitoring: - This part used by the researcher to assess ECG rhythm after the modified Valsalva maneuver. Normal ECG scored as zero, and abnormal ECG scored as1. Part (3) Numeric Rating Scale for measuring nausea (NRS). This scale was developed by Meek R et al (2009) and adopted by Wikström et al. (2019) and used by the researcher to assess the severity of nausea. Patients rated nausea on a 100-mm visual analogue scale (VAS) (0=least severe, 100=most severe) every 15 minutes until they left the Emergency Department (ED). Assessment was done more than one time to assess the prognosis of symptoms. At each assessment after the first one, patients are also asked to describe whether their nausea was ”a lot less,” ”a little less,” ”unchanged,” ”a little more,” or ”a lot more” compared with previous assessments. The authors defined the minimum clinically significant change in nausea as the mean difference in VAS scores for patients who reported ”a little less” or ”a little more” nausea. Part (4) Modified Borg Dyspnea Scale (MBS): This scale was developed by Boogaert et al (2000). It is a valid and reliable assessment tool. It used by the researcher to measure the severity of dyspnea as perceived by the patient in the Emergency Department. It consisted of 0 (No breathlessness at all) to 10(Maximal) rated scale given to the patient to evaluate their dyspnea at rest (Boshuizen et al., 2013; Hareendran et al., 2012 & Kendrick et al.,2000). The main result of the present study 1. It was found that nearly three quarter of the control and study groups patients were female. 2. More than half of patients were married and highest percentage (32.5%) of the patients in control group were between 50 to 60 years old, while the same percentage (32.5%) of the patients in study group were between 30 to 40 years old with a mean age of 43.88±11.303 for control group and 46.63 ± 10.60 for study group. 3. It is concluded that more than half of the patients in control and study groups diagnosed by Atrioventricular Node Re-Entrant Tachycardia (AVNRT). 4. It was found that nearly half of the patient in control and study groups had previous history of SVT. 5. It was observed that the same percentage (92.5%, 42.5%) of both control and study groups suffer from palpitation& fatigue. Also, more than half of both groups (55.0%) & (62.5%) suffer from dyspnea respectively 6. There was significant improving in relation to hemodynamic parameters for both control and study groups. 7. There was highly statically significant difference between control and study groups regarding ECG rhythm throughout periods of intervention. 8. No statistically significant difference was observed among control group regarding severity of nausea and dyspnea throughout periods of intervention. On the other hand, statistically significant difference was observed among study group throughout the periods of the intervention where P= 0.010 and 0.007 respectively. The recommendations from the present study Based on the finding of the current study, the following recommendations are derived and suggested: A. Recommendation for clinical practice - Modified Valsalva maneuver (MVM) should be carried out as a first-line vagal maneuver and routine care in subjects presenting with SVT in the emergency room. B. Recommendation for administration - Development of an in-service training program for nursing staff in cardiac care units about modified Valsalva maneuver to improve clinical outcomes and decrease complications. C. Recommendations for further research studies: - - To generalize the findings more broadly, the study could be done with bigger sample size and different cardiac care units. - Further studies are needed to increase follow up period post application of MVM for patients with supraventricular tachycardia. - Future work should assess the implementation and dissemination of this technique and its performance in routine practice. Studies comparing MVM with the fully supine Valsalva maneuver.