(Upright Tilt Testing)

Syncope or fainting, may occur rarely to frequently, depending on the cause. Some causes of syncope may include, but are not limited to:

• Vasovagal syndrome - 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.
• Valve disease - 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.

What is a Tilt Table Procedure?

A tilt table test is a procedure performed in patients who complain of syncope or passing out. 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 while connected to EKG and blood pressure monitors.

The bed or table is then elevated to an almost standing position to simulate the patient actually standing up from a lying position. The blood pressure and EKG 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.

Why is a Tilt Test Done?

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

What can I Expect?

DO NOT eat or drink anything for six to eight hours before the procedure.

If you are taking medications, your physician will give you instructions if any changes are to be made in the doses. Some medications may be held (not taken) for two to three days before the procedure.

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

Your physician will explain the tilt table procedure, its purpose, any risks, and the expected outcome before the procedure.

An intravenous (IV) line will be inserted in your hand or arm prior to the procedure.

EKG electrodes will be attached to your chest, so you will need to remove your shirt or blouse. You will be given a gown to wear.

You may be given a medication to speed up your heart during the procedure.

A special bed or table is used for the procedure.

• 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.
• EKG electrodes will be placed on your chest and attached to an EKG 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.

When all of the equipment is connected, the test will begin with you lying flat. The bed will be tilted upward so that you are almost upright.

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

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.

After the medication is given (if needed), you will again be tilted upright.

If symptoms occur, the test is considered positive for vasovagal syndrome.

You will be lowered to a flat position and allowed to rest for a while. Your heart rate and blood pressure will be monitored.

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

The entire procedure takes approximately one hour.

After the Procedure

• You may feel tired for several hours or longer after the procedure. Otherwise, you should feel normal within a few hours after the procedure, if not sooner.
• Depending on the results of the tilt table test, additional tests or procedures may be scheduled for further diagnostic information.