Tilt Table Evaluation

(Upright Tilt Testing)

Procedure overview

What is a tilt table procedure?

A tilt table procedure is a diagnostic procedure that may be used to evaluate a person who has symptoms of syncope (fainting). When a person has a complaint of syncope, the physician will carefully evaluate the person's past medical history and perform a physical examination. If basic components of the examination or history do not reveal a potential cause for the syncope, and the person has no history of heart disease, then further diagnostic procedures may be scheduled.

Syncope, or fainting, may be caused by various medical problems. Syncope may occur rarely to frequently, depending on the cause. Some causes of syncope may include, but are not limited to, the following:

• Vasovagal syndrome (also called neurocardiogenic syncope). A sudden drop in blood pressure with or without a decrease in heart rate that is caused by a dysfunction of the nerves controlling the heart and blood vessels.

• Arrhythmia (also called dysrhythmia). A heart rate that is too slow, too fast, or too irregular to maintain adequate blood flow to the body.

• Structural heart disease (abnormalities of the heart muscle or valves). Enlargement of the heart muscle or malfunction of one or more of the heart valves may cause an obstruction of the blood flow within the heart.

• Heart attack (also called myocardial infarction, or MI). Damage to the heart muscle due to insufficient blood supply.

• Ventricular dysfunction. A weakness or failure of the pumping function of the ventricles (the heart's major pumping chambers.

One type of diagnostic procedure that may be used to assess syncope is the tilt table procedure. This procedure attempts to cause syncope by creating changes in posture from lying to standing. This test is performed by having the patient lie flat on a special bed or table with special safety belts and a footrest while connected to electrocardiogram (ECG) and blood pressure monitors. The bed or table is then elevated to an almost standing position (60 to 80 degree vertical angle) to simulate the patient standing up from a lying position. The blood pressure and ECG are measured during the test to evaluate changes during the position changes. If the test causes an episode of syncope, then the cause of the syncope is vasovagal syndrome. The physician can then prescribe specific treatment for the syncope once the cause is known.

Other related procedures that may be used to assess the heart include resting or exercise electrocardiogram (ECG), Holter monitor, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, signal-averaged electrocardiogram, and cardiac CT scan. Please see these procedures for additional information.

Reasons for the procedure

A physician may order a tilt table procedure if recurring episodes of syncope (fainting) occur that have had certain other causes ruled out by other tests.

There may be other reasons for your physician to recommend a tilt table procedure.

Risks of the procedure

Possible risks of tilt table testing include, but are not limited to, the following:

• Episodes of syncope (fainting), which are planned for

• Dizziness or headache

• Hypotension (low blood pressure) or hypertension (high blood pressure)

• Nausea

• Palpitations and/or change in heart rate

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

• Notify the technologist if you are allergic to or sensitive to medications or latex.

• Fasting may be required before the procedure. Your physician will give you instructions as to how long you should withhold food and/or liquids.

• If you are pregnant or suspect that you may be pregnant, you should notify your physician.

• Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Notify your physician if you have a pacemaker.

• You should make arrangements to have someone drive you home after the procedure, as you will most likely be told not to drive afterwards.

• Based upon your medical condition, your physician may request other specific preparation.

During the procedure

A tilt table procedure may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a tilt table procedure follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You will be asked to remove clothing from the waist up and will be given a gown to wear.

3. You will be asked to empty your bladder prior to the procedure.

4. You will lie down on a special bed or table.

5. An IV line may be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.

6. ECG electrodes will be placed on your chest and attached to an ECG machine with wire leads. A blood pressure cuff will be placed on your arm and will be attached to an automatic blood pressure monitoring machine.

7. You will lie flat on the bed initially, then you will be raised to an almost standing angle while on the bed. Straps will be placed across your chest and legs to keep you from falling if you faint during the procedure.

8. You will remain upright for up to 45 minutes to determine if symptoms such as dizziness, fainting, low heart rate, and/or a low blood pressure occur.

9. If no symptoms occur, you may be given a medication in your IV to speed up your heart rate. This will be given while you are lying flat again.

10. After the medication is given (if needed), you will again be tilted upright and monitored for symptoms of dizziness, fainting, low heart rate, and/or a low blood pressure.

11. Once adequate data has been obtained, you will be lowered to a flat position and allowed to rest for a while. Your heart rate and blood pressure will be monitored.

12. When you are stable, the IV line, blood pressure cuff, and ECG electrodes will be removed.

13. You will be allowed to dress and leave, unless your physician instructs you differently.

After the procedure

You should be able to resume your normal diet and activities, unless your physician instructs you differently.

Generally, there is no special care following a tilt table procedure.

Notify your physician if you develop any signs or symptoms you had prior to the test (e.g., dizziness or fainting).

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.