Tilt table testing
What is a tilt table test?
A tilt table test is an out-patient diagnostic aid that helps clinicians determine if a patients symptoms are associated with a sudden drop in heart rate or blood pressure.
During the test patients lie on, and are secured to, a bed that can be moved slowly from horizontal to vertical so that the patient moves a lying down to a standing up position. Clinicians monitor heart rate and blood pressure while the body is gradually tilted.
Normally your blood pressure and heart rate will change according to your body’s needs, such as when you are sleeping or exercising. However, at times they may not respond appropriately to your body’s requirements and this may cause a sudden drop in your blood pressure/heart rate. This reaction may produce loss of consciousness (syncope) or a number of symptoms including dizziness or severe light-headedness (pre-syncope). Tilt testing is used to determine if you are having this type of reaction.
It is sometimes necessary for patients to stop some medications and avoid eating in advance of the test. Patients are routinely advised to remove make up so that so that any changes to the colour of the face can be observed.
It is frequently recommended that you are accompanied by a friend or relative so they can drive you home after the test. You may also wish to bring a change of clothes as some people very occasionally experience loss of bladder control during the test.
If you are asked to have a tilt table test, you can expect the following: Once you’re lying on the table, safety belts will be placed around you and your feet will be against a footplate to keep you from moving as the table tilts from horizontal to vertical.
Sensing electrodes are attached to your chest to monitor heart rate and rhythm during the test. A small cuff to measure blood pressure is placed around an arm, you will feel the cuff inflate and deflate throughout the test.
You will be asked to lie still and quiet during the test to prevent any disturbance to the information being recorded.
You may be given medication during the procedure but the clinician will discuss this with you when you arrive. Sometimes an intravenous cannula is inserted into a small vein on the back of the hand at the start of the test. This allows intravenous medication to be given. In some patients this improves the sensitivity of the test.
While you lie on the table, recordings of your blood pressure and heart rhythm will be taken. Once this is collected the table will then slowly tilt until you are in an almost upright position, where you will remain for approximately 45 minutes, your blood pressure and heart rhythm will be recorded throughout this time. On completion of the test the table will be lowered back to a lying position.
The length of time the test will take depends on when or if you experience a drop in your blood pressure or heart rate. Some people will demonstrate this within the first few minutes. Others will finish the complete test without any reaction. If no results have been recorded after approximately one hour the tilt bed will be lowered and the test terminated.
During the test you might experience seating or a number of other possible effects such as light-headedness, nausea, clammy, a “spacey” feeling, or a feeling as if you are about to faint/blackout. If you do lose consciousness this normally only lasts for a short period of time and the bed is lowered whilst you recover.
If you develop a drop in blood pressure/heart rate associated with symptoms your test will be classed as positive.
Some people develop symptoms even though their blood pressure remains normal. This would be considered a negative test.
The results of your test will be reported to your consultant. An appointment will then be made for you to return to discuss the results and any treatment options that may be needed.
If your test is positive you might experience all the usual sensations you experience during a natural episode. You will be allowed to fully recover before standing up and getting dressed. If you have a negative test, it is common to report feeling tired but otherwise fine.