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[Therapeutic effect of a nasal swab: an accidental vagal manoeuvre in a patient with supraventricular tachycardia].

BACKGROUND
The case gives the reader a valuable insight in pathophysiology and treatment in atrioventricular nodal re-entry tachycardia (AVNRT) and vagal manoeuvres available to treat this phenomenon.


CASE DESCRIPTION
A 85-year-old woman with a medical history of heart failure and aortic valve stenosis presents herself on the Emergency Department with cardiac shock and cardiac asthma. The ECG showed an AVNRT with 170 beats per minute (bpm) and a left bundle branch block (LBBB). After nasal swab for COVID-19 cardiac rhythm converted to a sinus or atrial tachycardia with 116bpm. The patients circulatory status improved and could then be treated with diuretics. Nasal swabs can lead to stimulation of the glossopharyngeal nerve with increase parasympathetic activity leading to a remission of atrioventricular re-entry tachycardia.


CONCLUSION
Nasal swabs can lead to increased parasympathetic activity in the atrioventricular node and cause conversion of supraventricular tachycardia to sinus rhythm.