Tilt
Table Procedure
(Upright
Tilt Testing)
What
is a tilt table procedure?
A tilt
table procedure is a diagnostic procedure that
may be used to evaluate a person who has symptoms
of syncope (fainting). When a person has a complaint
of syncope, the physician will carefully evaluate
the person's past medical history and perform
a physical examination. If basic components of
the examination or history do not reveal a potential
cause for the syncope, and the person has no history
of heart disease, then further diagnostic procedures
will be scheduled.
Syncope,
or fainting, may be caused by various medical
problems. Syncope may occur rarely to frequently,
depending on the cause. Some causes of syncope
may include, but are not limited to, the following:
- vasovagal syndrome
- a sudden drop in blood pressure
with or without a decrease in heart rate that
is caused by a dysfunction of the nerves controlling
the heart and blood vessels
- arrhythmia (Also called
dysrhythmia.) - a heart rate that
is too slow, too fast, or too irregular to maintain
adequate blood flow to the body
- valve disease -
malfunction of one or more of the heart valves
may cause an obstruction of the blood flow within
the heart
- heart attack (Also
called myocardial infarction, or MI.) -
damage to the heart muscle due to insufficient
blood supply
One
type of diagnostic procedure that may be used
to assess syncope is the tilt table procedure.
This procedure attempts to cause syncope by creating
changes in posture from lying to standing. This
test is performed by having the patient lie flat
on a special bed or table while connected to electrocardiogram
(ECG) and blood pressure monitors. The bed or
table is then elevated to an almost standing position
to simulate the patient actually standing up from
a lying position. The blood pressure and ECG are
measured during the test to evaluate changes during
the position changes. If the test causes an episode
of syncope, then the cause of the syncope is vasovagal
syndrome. The physician can then prescribe specific
treatment for the syncope once the cause is known.
Other
related procedures that may be used to assess
the heart include resting or exercise electrocardiogram
(ECG), Holter monitor, cardiac catheterization,
chest x-ray, computed tomography (CT scan) of
the chest, echocardiography, electrophysiological
studies, magnetic resonance imaging (MRI) of the
heart, myocardial perfusion scans, radionuclide
angiography, signal-averaged electrocardiogram,
and ultrafast CT scan. Please see these procedures
for additional information.
A physician
may order a tilt table procedure if recurring
episodes of syncope (fainting) occur that have
had certain other causes ruled out by other tests.
There
may be other reasons for your physician to recommend
a tilt table procedure.
Possible
risks of tilt table testing include, but are not
limited to, the following:
- episodes of syncope
(fainting), which are planned for
- dizziness or headache
- hypotension (low blood
pressure) or hypertension (high blood pressure)
- nausea
- palpitations and/or
change in heart rate
There
may be other risks depending upon your specific
medical condition. Be sure to discuss any concerns
with your physician prior to the procedure.
- Your physician will
explain the procedure to you and offer you the
opportunity to ask any questions that you might
have about the procedure.
- You will be asked to
sign a consent form that gives your permission
to do the test. Read the form carefully and
ask questions if something is not clear.
- Notify the technologist
if you are allergic to or sensitive to medications
or latex.
- Fasting may be required
before the procedure. Your physician will give
you instructions as to how long you should withhold
food and/or liquids.
- If you are pregnant
or suspect that you may be pregnant, you should
notify your physician.
- Notify your physician
of all medications (prescription and over-the-counter)
and herbal supplements that you are taking.
- Notify your physician
if you have a pacemaker.
- You should make arrangements
to have someone drive you home after the procedure,
as you will most likely be told not to drive
afterwards.
- Based upon your medical
condition, your physician may request other
specific preparation.
A tilt
table procedure may be performed on an outpatient
basis or as part of your stay in a hospital. Procedures
may vary depending on your condition and your
physician’s practices.
Generally,
a tilt table procedure follows this process:
- You will be asked to
remove any jewelry or other objects that may
interfere with the procedure.
- You will be asked to
remove clothing from the waist up and will be
given a gown to wear.
- You will be asked to
empty your bladder prior to the procedure.
- You will lie down on
a special bed or table.
- An intravenous (IV)
line may be started in your hand or arm prior
to the procedure for injection of medication
and to administer IV fluids, if needed.
- ECG electrodes will
be placed on your chest and attached to an ECG
machine with wire leads. A blood pressure cuff
will be placed on your arm and will be attached
to an automatic blood pressure monitoring machine.
- A special bed or table
will be used for the procedure. You will lie
flat on the bed initially, then you will be
raised to an almost standing angle while on
the bed. Straps will be placed across your chest
and legs to keep you from falling if you faint
during the procedure.
- You will remain upright
to determine if symptoms such as dizziness,
fainting, low heart rate, and/or a low blood
pressure occur.
- If no symptoms occur,
you may be given a medication in your IV to
speed up your heart rate. This will be given
while you are lying flat again.
- After the medication
is given (if needed), you will again be tilted
upright.
- You will be lowered
to a flat position and allowed to rest for a
while. Your heart rate and blood pressure will
be monitored.
- When you are stable,
the IV line, blood pressure cuff, and ECG electrodes
will be removed.
- You will be allowed
to dress and leave, unless your physician instructs
you differently.
You
should be able to resume your normal diet and
activities, unless your physician instructs you
differently.
Generally,
there is no special care following a tilt table
procedure.
Notify
your physician if you develop any signs or symptoms
you had prior to the test (e.g., dizziness or
fainting).
Your
physician may give you additional or alternate
instructions after the procedure, depending on
your particular situation.
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