| A tilt table test is a medical procedure often used | | | | symptoms, at which time he or she is given medical |
| ith symptoms of dizziness or lightheadedness, with | | | | attention, or after a set period of time (usually from 20 |
| or without a loss of consciousness (fainting), | | | | to 45 minutes, depending on the facility or individualized |
| suspected to be associated with a drop in blood | | | | protocol). |
| pressure or positional tachycardia are good | | | | Diagnostic symptoms |
| candidates for this test. | | | | A tilt table test is considered positive if the patient |
| Preparations | | | | experiences symptoms associated with a drop in |
| Before actually taking the Tilt Table Test, the patient | | | | blood pressure or cardiac arrhythmia. A normal |
| may be instructed to fast for a period before the | | | | person's blood pressure will not drop dramatically while |
| test will take place, and to stop taking any medications. | | | | standing, because the body will compensate for this |
| On the day of the tilt table test, a patient may be | | | | posture with a slight increase in heart rate and |
| monitored using an electrocardiogram (ECG) while | | | | constriction of the blood vessels in the legs. If this |
| lying down. Some facilities insert an intravenous line in | | | | process does not function normally in the patient, the |
| case the patient needs to be | | | | test could provoke signs and symptoms ranging from |
| given medication quickly; however, this may influence | | | | minor lightheadedness to a very severe cardiac |
| the results of the test and may only be indicated in | | | | episode, depending on the person. A common side |
| particular circumstances. More recently, most | | | | effect during tilt table testing is a feeling of heaviness |
| investigators monitor cerebral perfusion using mean | | | | and warmth in the lower extremities. This is due |
| flow velocity recording with transcranial | | | | to blood pooling in the legs and, to onlookers, the |
| doppler ultrasound in supine horizontal position, during | | | | patient's lower extremities may appear blotchy, pink, |
| and after head-up tilt. An 18 MHz ultrasound transducer | | | | or red. Dizziness or lightheadedness are also likely to |
| is placed on the temporal bone above the cheekbone, | | | | occur in susceptible patients. Tilt table testing could |
| using a head gear to hold the probe in place. | | | | provoke fainting or syncope. In fact, this is the |
| Procedure | | | | purpose of the test. It may not be appropriate, or |
| A tilt table test can be done in different ways and be | | | | indeed even possible, to stop the test before this |
| modified for individual circumstances. In some cases, | | | | occurs, as the drop in blood pressure or pulse rate |
| the patient will be strapped to a tilt table lying flat and | | | | associated with fainting can come on in seconds. This |
| then tilted or suspended completely or almost | | | | is why the patient's blood pressure and ECG should be |
| completely upright (as if standing). Most of the time, a | | | | continuously monitored during the test. In extreme |
| patient is suspended at an angle of sixty to | | | | cases, tilt table testing could provoke seizures, or |
| eighty degrees. Sometimes, the patient will be given a | | | | even cause the heart to stop. The heart resumes |
| drug, such as Glyceryl trinitrate or isoproterenol, to | | | | beating normally upon being returned to a flat or |
| create further susceptibility to the test. In all cases, the | | | | head-down position. If at any time in tilt table testing a |
| patient is instructed not to move. Symptoms, blood | | | | patient loses consciousness, he or she will be returned |
| pressure, pulse, electrocardiogram, and sometimes | | | | to a supine or head down position and will be given |
| blood oxygen saturation are recorded. The test ends | | | | immediate medical attention, which could include being |
| when the patient faints or has other significant | | | | given fluids or perhaps atropine or adrenaline. |