Vagal techniques
These techniques stimulate your vagus nerve, which can slow a fast heart rate. Practise them when you are well — but during an episode, do not let them delay urgent help if you have chest pain, fainting, severe breathlessness, or you feel very unwell. ntences, or feel too unwell to stand or speak normally.
1. Valsalva manoeuvre
Bear down for 10–15 seconds
- Sit down and lean slightly forward.
- Take a deep breath in.
- Close your mouth, pinch your nose, and bear down hard — as though straining on the toilet.
- Hold for 10–15 seconds (use the timer below).
- Release suddenly and breathe normally. Lie flat with legs raised if possible.
- Wait 30 seconds. If the fast rate continues, repeat up to 3 times.
2. Cold water dive reflex
Cold water on the face for 10–20 seconds
- Fill a bowl with cold water and ice if available.
- Take a deep breath in and hold it.
- Submerge your face (forehead, eyes, cheeks) in the cold water.
- Hold for 10–20 seconds (use the timer below).
- Lift your face out and breathe normally.
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.
3. 4–6 Breathing
Slow breathing to activate the vagus nerve
- Sit or lie comfortably.
- Breathe in gently through your nose for 4 seconds.
- Breathe out slowly through your mouth for 6 seconds.
- Repeat for 5 minutes (about 6 breaths per minute).
The circle expands as you inhale and contracts as you exhale. Learn more in the self-guided booklet.
When you finish, your nervous system has received the signal. You can close this page and return to what you were doing, unless the fast rate continues, comes back with chest pain, fainting, breathlessness at rest, or leaves you feeling too unwell to stand or speak normally.
When to use: the 5-step protocol
- Recognise: You feel your heart racing or fluttering.
- Record: Take a monitor recording immediately.
- Breathe: Start 4–6 breathing for 2 minutes.
- Try a manoeuvre: If still racing, try the Valsalva or cold water technique.
- Seek help: If it does not stop after 15 minutes, call 111 for advice. Call 999 instead — do not wait the 15 minutes — if you have chest pain, feel faint or collapse, are severely breathless, or feel acutely unwell.