Tilt Table Test (Heart Tilt Test)

Introduction

The Tilt Table Test, also known as the Heart Tilt Test, is a diagnostic procedure used to evaluate unexplained fainting (syncope). It helps doctors determine whether a sudden drop in blood pressure or heart rate is responsible for the fainting episodes.

Why Is It Done?

This test is typically performed when a patient experiences recurrent unexplained fainting or dizziness. It is especially useful in diagnosing vasovagal syncope (neurocardiogenic syncope), a condition where the body's autonomic nervous system improperly regulates heart rate and blood pressure.

How Does the Test Work?

During the test: 1. The patient lies flat on a special table. 2. Electrodes are attached to monitor heart activity (ECG), and a blood pressure cuff is placed on the arm. 3. The table is tilted to 60–80 degrees to simulate standing up. 4. The patient is observed for changes in heart rate, blood pressure, and symptoms of fainting. 5. The test may last 20 to 45 minutes or longer if needed. 6. In some cases, a medication (like isoproterenol or nitroglycerin) is given to induce a response.

What Do the Results Mean?

• Normal Response: Stable heart rate and blood pressure with no fainting.
• Positive Test (Abnormal Response): A significant drop in blood pressure and/or heart rate, leading to fainting, suggests vasovagal syncope or orthostatic hypotension.

Risks Associated with the Test

This is a generally safe test, but there is a slight risk of: - Fainting (which is the purpose of the test but is quickly reversed by returning the table to a flat position). - Irregular heart rhythms (arrhythmias), though rare.

Treatment Options If the Test Is Positive

If the test confirms a diagnosis, treatment may include: - Lifestyle changes (hydration, salt intake adjustment, avoiding triggers). - Medications (fludrocortisone, beta-blockers, midodrine, or serotonin reuptake inhibitors). - Physical counter-maneuvers like leg crossing to prevent syncope. - Pacemaker (in rare cases) if severe bradycardia (low heart rate) is detected.

Conclusion

The tilt table test is a valuable tool in diagnosing fainting episodes. It helps distinguish between different causes and guides treatment decisions. If you experience recurrent fainting, you should consult a cardiologist to determine if this test is necessary.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines on the Evaluation and Management of Syncope

1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000499
2. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/03/07/23/36/2017-acc-aha-hrs-guideline-for-syncope
3. https://pubmed.ncbi.nlm.nih.gov/28280231/
4. https://www.jacc.org/doi/10.1016/j.jacc.2017.03.003
5. https://www.heartrhythmjournal.com/article/S1547-5271%2817%2930298-9/abstract

2. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Management of Syncope

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/39/21/1883/4939241
3. https://pubmed.ncbi.nlm.nih.gov/29562304/
4. https://www.hrsonline.org/guidance/clinical-resources/2009-guidelines-diagnosis-and-management-syncope
5. https://www.jacc.org/doi/10.1016/j.jacc.2019.09.012