Tilt Table Testing

What is a tilt table test?

A tilt table test is done to evaluate symptoms of fainting (syncope) or near fainting. If you have syncope, your healthcare provider will carefully review your health history and do a physical exam. If the results of the exam or history don't show a cause for the syncope, and you have no history of heart disease, then you may need further tests.

A tilt table test tries to find the cause of syncope by creating changes in posture from lying to standing. You will lie flat on a special bed or table with safety belts and a footrest. You will be connected to electrocardiogram (ECG) and blood pressure monitors. The bed or table is then raised to an almost standing position ( 60-degree to 80-degree vertical angle) to simulate standing up from a lying position.

The blood pressure and electrocardiogram (ECG) are measured during the test to evaluate changes during the position changes. If the test makes you faint, the table will quickly be returned to a flat position to help you regain consciousness. If no changes are seen and symptoms are not reproduced, you may be given a medicine such as isoproterenol or nitroglycerin to try and provoke symptoms. The information collected can then be used to help your healthcare provider prescribe treatment.

Why might I need the tilt table test?

You may need a tilt table test if you have recurring fainting and other causes were ruled out.

Syncope, or fainting, may be caused by many health problems. Syncope may happen rarely or frequently, depending on the cause. Some causes of syncope may include:

• Vasovagal syndrome. This is also called neurocardiogenic syncope. This is a sudden drop in blood pressure with or without a decrease in heart rate. It’s caused by an exaggerated response of nerves that control the heart and blood vessels.

• Orthostatic syncope. This is when your blood pressure drops when you stand up quickly or after you have been standing for a long time. The drop in blood pressure may be related to pooling of blood in the legs and poor return of blood up to the brain.

• Arrhythmia. This is when a heart rate is too slow, too fast, or is irregular. When this happens, the heart can’t get enough blood flow to the body.

• Structural heart disease. This means problems of the heart muscle or valves. Enlargement of the heart muscle or a defect in 1 or more of the heart valves may block blood flow within the heart.

• Heart attack. This is also called myocardial infarction (MI). This is damage to the heart muscle due to poor blood supply.

• Cardiomyopathy, ventricular dysfunction. This is a weakness or failure of the pumping function of the heart’s major pumping chambers (ventricles).

There may be other reasons for your healthcare provider to advise a tilt table test.

What are the risks of the tilt table test?

Possible risks of tilt table testing include:

• Planned episodes of syncope (fainting)

• Dizziness or headache

• Low blood pressure or high blood pressure

• Nausea

• Palpitations or change in heart rate

There may be other risks depending on your specific medical condition. Talk to your healthcare provider about any concerns before the test.

How do I get ready for the tilt table test?

• Your healthcare provider will explain the test to you and you can ask questions.

• 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.

• Tell the technologist if you are allergic to or sensitive to any medicines or latex.

• Fasting may be required before the test. Your healthcare provider will give you instructions as to how long you should withhold food or liquids.

• If you are pregnant or think you may be, tell your healthcare provider. Tilt table testing may be avoided in pregnancy.

• Tell your provider all the medicines (prescription and over-the-counter), vitamins, and herbal supplements that you are taking.

• Tell your provider if you have a pacemaker or an implanted cardioverter defibrillator.

• Based on your medical condition, your provider may request other specific preparation.

What happens during the tilt table test?

A tilt table test may be done on an outpatient basis. This means you go home the same day. Or it may be done as part of a hospital stay. Procedures may vary depending on your condition and your healthcare provider’s practices.

Generally, a tilt table test follows this process:

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

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 before the procedure.

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

5. An IV (intravenous) line will be started in your hand or arm to inject medicine and to give 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 for a few minutes. 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 test.

8. You will stay upright for up to 20 to 45 minutes to see if symptoms such as dizziness, fainting, low heart rate, or low blood pressure occur.

9. If no symptoms happen, you may be given a medicine in your IV line to speed up your heart rate or to lower your blood pressure. This will be given while you are lying flat again.

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

11. Once enough information is gathered, you will be lowered to a flat position and allowed to rest for a while. Your heart rate and blood pressure will be watched.

12. Sometimes the technician may massage the sides of your neck to see if a slow heart rate can be induced.

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

14. You will be allowed to dress and leave, unless your healthcare provider tells you differently.

What happens after the tilt table test?

You should be able to resume your normal diet and activities, unless your healthcare provider tells you differently.

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

Tell your provider if you develop any signs or symptoms you had before the test (such as dizziness or fainting).

Your provider may give you other instructions after the test, depending on your situation.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure