The purpose of this article is to provide a simple educational overview for staff members about tilt table testing. Although the specifics of this test can vary from place to place, there are fundamental basics that should be understood. Therefore, our goal is to give a brief outline of what to grasp when performing this test. With the help of the Providence Heart Institute s EP lab team and director Dr. Christian Machado, we will cover the how to of tilting.

What is a tilt table test?

A tilt table test is performed for the study and evaluation of syncope. For patients who have had episodes where they have unexplainably passsed out or lost consciousness, felt nauseated or dizzy, experienced vertigo or lightheadedness, or even blacked out, this test will attempt to understand why. Patients are tilted in an upright position on a table to assess their tolerance to this stress. Documenting blood pressure, level of consciousness, and heart rate consistently throughout the test are very important tools for a full assessment. The time and angle the patient is tilted varies from institution to institution. Medication may also be used, depending on the institution s conception of tilting. It is important to note that the tilt table test is not the only test that should be considered in understanding syncopal episodes.

What can the test show?

This test is designed to see if the physiological systems in your body are working properly. The trigger for patients that causes their episodes may usually be typical and follow a pattern. This includes many activities or anything that causes stress, heat, hunger, or dehydration. Autonomic dysfunction (dysautonomia) and vasovagal syncope have many different ways of revealing themselves.

Neurocardiogenic syncope pertains to the brain, heart and blood flow. If there is not adequate communication between these systems, patients may become symptomatic, which could reveal important information and discovery for understanding what happened during their syncopal episode. At a tilted position, the blood in the body may pool to the extremities (the patient may feel tingling or funny in their arms and legs), and it is the responsibility of the brain to recognize this and tell the heart to work harder. There has to be compensation by the brain and heart to avoid a positive tilt table test for neurocardiogenic syncope. The blood flow has to keep moving and this mechanism needs to respond appropriately. If this is not the case, there will be definite signs and evidence in the patient s intolerance to the test as well as visible changes in their vital signs.

Postural Orthostatic Tachycardia Syndrome (POTS) also deals with a physiologic inability to respond in the standing position. In POTS, you will see a significant increase in a patient s heart rate (greater than or equal to 30 beats per minute [bpm]) within the first 10 minutes of being tilted. So, for example, the patient may have a heart rate of 65 bpm in the supine position, but this could jump to 103 bpm as soon as they are tilted to an upright position. During POTS, the heart rate will remain elevated throughout the duration of the test. Although the patient may not pass out with this jump in their heart rate, they still may become symptomatic. In this case, a physician may recommend treatment for POTS.

How do you do the test?