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A tilt table test (TTT), occasionally called upright tilt testing (UTT), is a
medical procedure A medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagnosis, diagnosing a patient condition or parameter is also called a medi ...
often used to
diagnose Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". ...
dysautonomia Dysautonomia, autonomic failure, or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This condition may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and ...
or syncope.
Patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ...
s with
symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...
s of dizziness or lightheadedness, with or without a loss of
consciousness Consciousness, at its simplest, is awareness of a state or object, either internal to oneself or in one's external environment. However, its nature has led to millennia of analyses, explanations, and debate among philosophers, scientists, an ...
(
fainting Syncope , commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from ...
), suspected to be associated with a drop in
blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...
or positional
tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...
are good candidates for this test. The procedure tests for causes of syncope by attempting to cause syncope by having the patient lie flat on a special table or bed and then be monitored with
ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of ...
and a blood pressure monitor that measure continuous, beat to beat, non-invasively. The table then creates a change in posture from lying to standing.


Indications

TTT may be indicated when the initial evaluation for syncope fails to provide a definitive, highly probable, or potential diagnosis, but instead raises clinical suspicion of reflex syncope, orthostatic hypotension, postural orthostatic tachycardia syndrome, or psychogenic pseudosyncope. TTT can help further investigate these conditions and aid in establishing an accurate diagnosis.


Preparations

Before taking the test, the patient may be instructed to
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for a period before the test will take place and to stop taking any medications. On the day of the tilt table test, an
intravenous line Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
may be placed in case the patient needs to be given
medications Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...
quickly; however, this may influence the results of the test and may only be indicated in particular circumstances. More recently, many investigators monitor
cerebral perfusion pressure Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (havin ...
using mean flow velocity recording with transcranial Doppler ultrasound in supine horizontal position, during and after head-up tilt. An 18 MHz ultrasound transducer is placed on the temporal bone above the cheekbone, using headgear to hold the probe in place.


Procedure

A tilt table test can be done in different ways and be modified for individual circumstances. In some cases, the patient will be strapped to a tilt table lying flat and then tilted or suspended completely or almost completely upright (as if standing). Most of the time, the patient is suspended at an angle of 60 to 80 degrees. Sometimes, the patient will be given a drug, such as
glyceryl trinitrate Nitroglycerin (NG) (alternative spelling nitroglycerine), also known as trinitroglycerol (TNG), nitro, glyceryl trinitrate (GTN), or 1,2,3-trinitroxypropane, is a dense, colorless or pale yellow, oily, explosive liquid most commonly produced by ...
(nitroglycerin) or
isoproterenol Isoprenaline, also known as isoproterenol and sold under the brand name Isuprel among others, is a sympathomimetic medication which is used in the treatment of acute bradycardia (slow heart rate), heart block, and rarely for asthma, among other ...
, to create further susceptibility to the test. In all cases, the patient is instructed not to move. Symptoms, blood pressure, pulse, electrocardiogram, and sometimes blood oxygen saturation are recorded. The test either ends when the patient faints or develops other significant symptoms, or after a set period (usually from 20 to 45 minutes, depending on the facility or individualized protocol).


Diagnostic symptoms

A tilt table test is considered positive if the patient experiences symptoms associated with a drop in blood pressure or
cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beat ...
. A normal person's blood pressure will not drop dramatically while standing, because the body will compensate for this posture with a slight increase in heart rate and constriction of the
blood vessels Blood vessels are the tubular structures of a circulatory system that transport blood throughout many animals’ bodies. Blood vessels transport blood cells, nutrients, and oxygen to most of the tissues of a body. They also take waste an ...
in the legs. If this process does not function normally in the patient, the test could provoke signs and symptoms ranging from minor lightheadedness to a very severe cardiac episode, depending on the person. A common side effect during tilt table testing is a feeling of heaviness and warmth in the lower extremities. This is due to
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is com ...
pooling in the legs and, to onlookers, the patient's lower extremities may appear blotchy,
pink Pink is a pale tint of red, the color of the Dianthus plumarius, pink flower. It was first used as a color name in the late 17th century. According to surveys in Europe and the United States, pink is the color most often associated with charm, p ...
, or
red Red is the color at the long wavelength end of the visible spectrum of light, next to orange and opposite violet. It has a dominant wavelength of approximately 625–750 nanometres. It is a primary color in the RGB color model and a seconda ...
. Dizziness or lightheadedness are also likely to occur in susceptible patients. Tilt table testing could provoke fainting or syncope. It is the purpose of the test to provoke these symptoms, in order to aid in diagnosis. It may not be appropriate, or indeed even possible, to stop the test before fainting occurs, as the drop in blood pressure or pulse rate associated with fainting can come on in seconds. This is why the patient's blood pressure and ECG should be continuously monitored during the test. If at any time in tilt table testing a patient loses consciousness, they will be returned to a supine or head down position and will be given immediate medical attention, which could include being given fluids or perhaps
atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically give ...
or a sympathomimetic drug like epinephrine or
ephedrine Ephedrine is a central nervous system (CNS) stimulant and sympathomimetic agent that is often used to prevent hypotension, low blood pressure during anesthesia. It has also been used for asthma, narcolepsy, and obesity but is not the preferred ...
which will raise blood pressure and heart rate rapidly. In extreme cases, tilt table testing could provoke
seizures A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
or even cause the heart to stop. The heart resumes beating normally upon being returned to a flat or head-down position. A drop in blood pressure during the tilt table test is indicative of
orthostatic hypotension Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when they are standing up ( orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as ne ...
. A marked increase in heart rate in the absence of orthostatic hypotension is indicative of
postural orthostatic tachycardia syndrome Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, ...
.


See also

* Dix–Hallpike test


References


External links


2004 European Society of Cardiology Guidelines on Management (Diagnosis and Treatment) of Syncope.
{{Use dmy dates, date=June 2025 Diagnostic cardiology Diagnostic neurology Physical examination