Do vagal maneuvers have contraindications?

• A. There are none
• B. There are contraindications
• C. They are contraindicated in all patients with chest pain
• D. Vagal maneuvers should never be used in tachyarrhythmias

Answer: (B)

Vagal maneuvers slow conduction through the AV node to help terminate certain narrow-complex tachycardias, but they are not without risk. Because of that, there are specific situations where performing them would be unsafe. The key safety concern is carotid sinus massage, which can dislodge plaques or reduce cerebral blood flow in patients with carotid artery disease. This makes carotid massage contraindicated in people with known carotid artery disease, a carotid bruit, or a recent TIA/stroke. Other neck or vascular abnormalities can also raise risk.

So there are indeed contraindications to vagal maneuvers, which is why the best choice is that contraindications exist. They are not universally safe in all chest pain, and they are not never to be used in tachyarrhythmias; when appropriate and safe, vagal maneuvers remain a first-line option for certain stable SVTs.