Tilt Table Test

A tilt table test is also known as a “Head up tilt test” or “Tilt test“. The tilt table test (TTT) is a test performed to deduct the causes of unusual dizziness or fainting. This test is said to be simple, informatory, and does not require an incision of the human skin before performing the test.

This tilt table test relates fainting or dizziness to the heart and blood pressure and it dates far back to the 1980s. It provides information about people possessing syncope.

WHY IT IS DONE?

A tilt table test is done when a patient passes out frequently without cause or the feeling of dizziness is always felt. The patient tends to consult a doctor which results in the test. 

In this process, the blood pressure and heartbeat are observed repeatedly to deduct any form of irregularities. Therefore, placing the body in an upright manner while performing the test lowers the heart rate and blood pressure over a short period resulting in fainting.  This action causes a replicate of the syncope providing the doctor with a better understanding of the situation. 

The tilt table test is mainly conducted alternatively after the natural causes of the syncope which are the heart and cerebrovascular diseases are not detected by either the brain magnetic resonance imaging (MRI), electrocardiogram (EKG), brain magnetic resonance angiography (MRA), or the echocardiogram. Then, the doctor recommends the tilt table test.

The tilt table test is also performed to observe feasible hypertension as some patient’s heart rate decreases when they attempt to stand upright preventing the flow of blood into the arms and legs resulting in fainting. 

Also, it is done to examine a possible “Postural Orthostatic Tachycardia Syndrome (POTS)” which arises from standing upright just for 10 minutes after sitting down for some time leading to an increase in heart rate then fainting.

ELIGIBILITY

Any patient that feels nauseous, dizzy, or faints unusually is liable to undergo the tilt table test.

PREPARATION

The tilt table test is usually performed in a doctor’s office based on the capabilities. 

The requirements for the patient undergoing the test are listed below:

1. The patient is required to put on comfortable clothes that can easily be removed as the patient will be asked to change to a hospital gown.
2. The patient must restrict food intake or drink any liquid within a three to four-hour range before undergoing the test as the test can trigger a nauseous feeling.
3. Identification, test order form, and form of payment should be brought for the test alongside a person that will take care of the patient after the test.

PROCEDURE

The steps involved in performing the tilt table test are classified into before, during, and after test and these tests are listed below:

• Before the Test,

The patient is required to relate information about medications used within the period in case the doctor prescribes no form of medication before the test.

• During the Test,

The doctor will have one or more other physicians present to render assistance while performing the test.

The patient will be required to lay down on an examination table and be strapped to the table to remain firm in the position when moved. A cuff that indicates the reading of the blood pressure is placed on the arm of the patient alongside electrocardiogram leads positioned on the chest.

A pulse oximeter will then be used to observe the pulse in the patient with the saturation of the oxygen in the system. A pulse oximeter is a little object clipped to the tip of the finger which permits the indication of the pulse on the screen. An intravenous (IV) infusion might be inserted into the arm in case medication is to be administered to the patient. 

While laying down, the physicians take note of the current vitals before adjusting the examination table to an angle of 30 degrees above the body, then, the vital signs are noted as the elevation causes a change in the pulse levels and heartbeat. 

The physician increases the inclination further to 60 degrees and the heart rate is noted once more before finally adjusting to 90 degrees. 

Then vital signs like the oxygen level, blood pressure, and heartbeat are carefully observed after standing motionless for 20 to 60 minutes. 

Observations made by the physician determine whether the patient will be taken placed back horizontally. Excess Blood pressure drops or a feeling of dizziness might occur, therefore, the physician returns the examination table to its original horizontal position.

Patients whose vital signs remain normal following the effect of changes in the inclination when strapped tend to advance to the next phase of testing. 

In this phase, some patients are injected with “Isuprel (isoproterenol) or nitroglycerin” to increase the heartbeat and effecting the conclusions to be drawn from the symptoms. While patients possessing symptoms already don’t need the injection.

• After the Test,

After the tilt test, the straps are removed, the recovery process starts. Some patients may feel nauseous, so instructions will be given on when to eat and drink before being taken home. Recovery can take few hours.

DURATION

It will take approximately 12 hours to conduct and recover from the test but it takes about one hour to conduct the tilt table test and this information will be related to the patient for consent’s sake.  

The output of the result depends on the team of physicians examining the result before passing the report to the doctor for final assessment.

RESULT

The major factors affecting the result after undergoing the tilt test are the blood pressure, pulse, and whether the patient fainted during the test.

If the blood pressure of the patient decreases swiftly during the test, the heart rate increases rapidly and the patient faints during the tilt table test, then the result is noted positively. While if the blood pressure doesn’t reduce rapidly, the heart rate increases slightly and there was no sign of dizziness, then the result is negative. 

Though, more tests will need to be conducted to diagnose the cause of the dizziness and fainting.

RISK

The tilt test is deemed safe with little or no complications. Few complications that can be encountered are:

1. Few hours of weakness mainly two to three hours.
2. Blood pressure reduction for few hours after the test.
3. Vomiting.
4. Nausea.
5. Fainting.

SPECIALTY

A trained doctor performs the test alongside physicians or nurses for assistance. The tilt table test is an easy procedure so no specific medical professional is required.

COST

The cost of a tilt table test ranges from $500 to $1000 in the U.S., depending on the hospital. However, it varies in other countries.

 

FAQs

• How long does it take to do a tilt table test?

The tilt table test takes about 90 minutes to accomplish when the two phases are performed but for the first phase only, it takes about 30 to 40 minutes.

• Are tilt table tests accurate?

The tilt table test is not reliable with about 70% effectiveness and it is used as an alternative when the natural causes of syncope are not found with normal brain imaging tests.

• Does the heart stop when you faint?

The heart does not stop when you faint, you can lose consciousness when having seizures but it is not termed fainting.

• What causes lightheadedness when standing up?

Orthostatic hypertension is what causes lightheadedness when standing up.

• What happens when you pass out during a tilt table test?

Passing out during a tilt table test shows that the blood pressure of the patient decreased rapidly, heart rate increases and there is a low rate of blood flowing to the brain resulting in fainting, therefore, the patient is placed horizontally again