View source for Teaching counter pressure maneouvres

''N. van Dijk, C.T.P. Krediet and W. Wieling''<br/>
''N. van Dijk, C.T.P. Krediet and W. Wieling Department of Medicine. Academic Medical Centre, University of Amsterdam. Amsterdam (The Netherlands)''<br/>

A 49-year old male with a clinical history of recurrent vasovagal syncope underwent tilt table testing. Blood pressure was measured continuously and its tracing was shown on a 15 inch computer monitor placed next to the tilt table. The provoked vasovagal reaction was counteracted by leg crossing and tensing of leg, abdominal and buttock muscles (+) while in head-up tilt position. The effect was reproducible. 
Then he was asked to stop the countermanoeuvre and step off the tilt table, upon which vasovagal symptoms returned. Standing next to the tilt table he was educated on the application of physical countermanoeuvres in front of a computer video screen. Leg crossing with muscle tensing  (+); squatting and sitting down with legs crossed were practiced to combat vasovagal hypotension. During this training session the continuous blood pressure tracing on the computer video screen was used as feedback to instruct the patient to perform the manoeuvres effectively. 

[[File:TeachingCounter_Fig1.jpg|thumb|600px|Fig 1. Continuous blood pressure recordings during manoeuvres (see text).]]