Tilt table

Tilt Table Test – Arizona Heart Rhythm Center pdf2

Will my medications interfere with the test?

Very few medications actually interfere with a tilt table test. However, there are some medications which may affect the interpretation of the test. Patients should ask their physician or the physician ordering the tilt table test, whether or not they should continue to take their medications.

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If I have diabetes, should I take my medication on the morning of the test?

Patients that have diabetes mellitus and are using insulin or taking medication to control their blood sugar should talk their physicians prior to their tilt table test. Usually, patients with diabetes will have to adjust their insulin or their medication on the day of their tilt table test in order to avoid their blood sugar from dropping too low.

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Can I drive home after the test?

Many patients will drive home after the test. Since most patients return to feeling normal within 15 minutes after the test, there is no problem driving home after the test. The test itself, whether positive or negative, however, is quite tiring. For patients that live some distance from the hospital, we encourage them to bring someone else along with them who can drive them home in case the patient feels too tired to drive a long distance.

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How will I feel after the tlit table test?

Many patients who have a positive test feel a little unsettled and sometimes nauseous for the first few minutes after the test. We allow patients to fully recover prior to having them stand up and get dressed. The vast majority of patients will return to feeling completely normal within 5 to 10 minutes after the test. Rarely, a patient may continue to experience weakness or fatigue for a longer period of time after the test. Patients that have a negative test often report that the test was tiring but otherwise feel fine.

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Does everyone faint during a tilt table test?

Few patients faint during a tilt table test. The vast majority of patients that have a positive test do not faint because we can see their blood pressure falling and we can return the table to the horizontal position before the patient faints. Typically, patients experience lightheadedness while their blood pressure is falling and while we are lowering them to the horizontal position. Rarely, a patient”s blood pressure will fall so fast that they faint. These patients who do faint are usually only “out” for a few seconds and wake up as they are being lowered to the horizontal position. Patients have safety straps around them to prevent them from falling off the table if they do faint. There is always a doctor and a nurse in the room with the patient during the periods when the patient is tilted head-up to 60 degrees.

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What does a positive test mean?

A positive tilt table test means that a patient is susceptible to one of the reactions that can cause a drop in blood pressure. Some of the reactions can be dangerous and require treatment, other reactions are benign and may not require treatment. Treatments vary from medication to a change in diet. The interpretation of the tilt table test is up to your physician. Your physician knows you best and is the best person to interpret your test and recommend treatment.

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What is a positive test?

A tilt table test is called positive if a patient develops a drop in blood pressure associated with symptoms. The symptoms that patients experience are varied and have included lightheadedness, nausea, a cold and clammy feeling, sweating, a “spacey” feeling, or a feeling like you are about to black out. Rarely, blood pressure falls without the patient developing symptoms. In these cases, we try to continue the test until the patient develops symptoms. Some patients develop symptoms even though their blood pressure remains normal. While this is a negative test, we do report the symptoms in the report and the corresponding blood pressure. In these cases the symptoms are not explained by changes in blood pressure or heart rate.

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How long will the tilt table test take?

The duration of the tilt table test depends in part on how you respond. Some patients demonstrate the reaction that causes their blood pressure to fall suddenly in the first 20 minutes of head-up tilt to 60 degrees. Given the time it takes to set up the equipment and collect baseline data, the shortest possible test is 30-40 minutes. Other patients finish the entire protocol without demonstrating any such reaction (a negative test); these patients therefore finish both stages of the test. If you finish the entire test, it will take approximately 1 hour.

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Do I have to have an intravenous line placed?

It is possible (although rare), that a patient may have a reaction during the test that would require us to administer a medication intravenously. Even though the chance of such a reaction occurring is extremely rare, we prefer to have the intravenous line already in place as a safety measure.

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What does tilt table testing involve (the protocol)?

Tilt table test evaluates how blood pressure responds to the simple stress of standing up, or in other words, how the blood pressure responds to the stress of gravity (without or with pharmacologic provocation). Patients are asked to remove their clothing above the waist, put on a hospital gown, and lie down on a special table. Patients are connected to an electrocardiogram (ECG) type machine, have a small cuff placed around a finger which measures blood pressure, and have a small intravenous line (IV) placed into a vein in the arm. We try to make the setting as relaxing as possible by dimming the lights and by turning on some soft music in the background. After everything is set up we collect baseline blood pressure and ECG data for while you lie quietly on the table. After we have collected baseline data, the table will tilt you head-up to 60 degrees. Even though you are lying on a table that is at a 60 degree angle, it feels as though you are standing on a footboard at the bottom of the table. You will be weight bearing. You will have two safety straps placed around your waist and your knees to make you feel secure. We will be observing your blood pressure and ECG while you are head-up at 60 degrees for 20 minutes. There is no doubt that remaining still, essentially standing, for 20 minutes can be mildly uncomfortable. Talking during the procedure actually disturbs our measurements of your ECG and your blood pressure so we ask you to be still and quiet. If you develop symptoms of any kind, however, we do want you to tell us. We try to make it as comfortable as possible for you. If you become extremely uncomfortable and cannot go on we will stop the test. If you complete the 20 minute period of head-up tilt at 60 degrees without developing a drop in your blood pressure, we will lower the table until you are flat and begin the second part of the test. The second part of a tilt table test evaluates how blood pressure responds to a stress caused by a medications. The medication we use is called either sublingual nitroglycerine or IV isuprel. During this second part of the tilt table test, we infuse a very small dose of isuprel or administer sublingual nitroglycerine. You will feel your heart beating a little faster and stronger; some patients say if feels strange because they feel like they are exercising a little even though they are lying flat. We will observe you at 60 degrees for 20 minutes. If you complete the 20 minutes of head-up tilt during the infusion of isuprel or after sublingual nitroglycerine, the table will be returned to the flat position.

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Who needs a tilt table test?

Patients that have symptoms suggestive of a sudden drop in blood pressure or heart rate may benefit from the evaluation of blood pressure/ heart rate regulation with a tilt table test. The tilt table test was originally designed to evaluate patients with fainting spells because many fainting spells are caused by a drop in blood pressure and heart rate. Tilt table testing may also be useful for patients who have symptoms of severe lightheadedness or dizziness which don”t actually cause them to faint, but force them to sit down or lie down. These symptoms, while not progressing on to an actual fainting spell, may still be indicative of a sudden drop in blood pressure.

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What is a tilt table test?

Tilt table testing is designed to evaluate how your body regulates blood pressure in response to some simple stresses/stressors. Blood pressure is regulated by a set of nerves which operate continuously and subconsciously and are part of the autonomic nervous system. This set of nerves detects certain bodily needs and they respond by causing the appropriate changes in blood pressure. The purpose of this part of the autonomic nervous system is to insure that there is always enough blood going to the brain, and to distribute blood to other organs according to their needs. These changes in blood pressure are accomplished by making changes in the way the heart beats and by making changes in the caliber or size of certain blood vessels. At times, the nerves which control blood pressure may not operate properly and may cause a reaction which paradoxically causes the blood pressure to drop suddenly. This reaction may produce a fainting spell or a number of symptoms including severe lightheadedness and nausea. Tilt table testing is designed to determine the likelihood that a patient is susceptible to this type of reaction.

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