Tilt Table Test

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Tilt Table Test

 

Definition

The tilt table test is a test in which a patient is positioned in a supine position and brought to a predetermined angle or angles from the horizontal position. Such positioning helps to determine the cause of any decrease in oxygen to the brain. Different types of drugs may also used in the testing process.

Purpose

The purpose of the tilt table test is to help determine appropriate therapy for individuals with fainting (syncope) and presyncope of unexplained origin.

Precautions

Precautions are few with the tilt table test. However, when any drug is used with this test, the appropriate precautions for that particular drug should be observed. For example, when isoproterenol or similiar drugs are used during the tilt table test, the taking of non-prescription drugs for asthma, cough, cold, or allergy; appetite suppressants; sleeping pills; or drugs containing caffeine should be made known to the physician prior to the test. Likewise, the physician should be informed of any allergies to any sympathomimetic drugs, including several of the diet pills on the market. The physician should be told of any serious heart-rhythm disorders.

Description

Syncope is described as a pathological brief loss of consciousness caused by a temporary deficiency of oxygen in the brain. Previous studies have shown the effectiveness of tilt table testing in establishing the diagnosis of neurocardiogenic syncope, and in dictating therapy in patients with syncope of unknown origin. Despite its usefulness, small numbers of patients and brief followup reports have limited the majority of studies. Sensitivity-enhancing techniques, such as the administration of isoproterenol, are applied in specific cases to children and young adults to compensate for the otherwise low sensitivity (20-30%) observed in that population.

Preparation

In order for a patient to make informed decisions about any diagnostic test or procedure, there are important questions that need to be asked prior to the procedure. The information gained will be helpful for that patient in determining benefits, risks, and cost of the procedure, and alternatives. The patient should understand the purpose of the tilt table test, and the diagnosis that the physician is trying to confirm or rule out. If the tilt table test is positive, the patient should ask questions about the frequency of false-positive results for that particulare tilt table procedure, and should inquire about the next step in treatment.

Aftercare

After the procedure, the patient is asked to transfer from the supine position to a sitting position, and is observed for a short period of time. During this time and after several minutes in the sitting position, any symptoms of dizziness and vertigo are noted. When ready, the individual transfers from the sitting position to standing. After additional observation and taking of vital signs, the individual is allowed to go home.

Risks

Risks of the tilt table test are low, but do include significant changes in blood pressure while in the supine position, and any adverse reactions to any drugs administered during the tilt table test.

Normal results

Normal results of the tilt table test should help the physician in assessing what may or may not be the cause of the syncope.

Abnormal results

Abnormal results include any pathologic reactions to the position changes or sensitivity enhancing techniques, such as the administration of isoproterenol or other related drugs.

Key terms

Sympathomimetic — Denoting a drug that mimics the effects of stimulation of organs and structures by the sympathetic nervous system. The sympathetic nervous system pertains to the part of the nervous system originating in the thoracic and lumbar regions of the spinal cord. In general, it inhibits or opposes the physiological effects of another aspect of the nervous system, as in tending to reduce digestive secretions, speed up the heart, and contract the blood vessels.
Syncope — A loss of consciousness over a short period of time, caused by a temporary lack of oxygen in the brain.
Vertigo — The sensation of dizziness.

Resources

Organizations

American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000. http://www.amaassn.org.
References in periodicals archive ?
Del Pozzi et al showed that POTS patients have an initial increase in respiratory rate and a significant in crease in minute ventilation during head-up tilt table testing compared to normal controls (19).
The efficacy of pacemaker therapy was questioned after two recent trials (7, 8); which failed to prove the superiority of pacing over placebo in 'unselected' patients with positive tilt table testing (mostly without cardioinhibition).
Other diagnostic tests to consider include MRI, laboratory tests, cardiovascular testing, ambulatory EKG, and tilt table testing.
Patients who initially had difficulty identifying their prodrome were helped by using tilt table testing to induce vasovagal episodes.
et al, Tilt table testing for Evaluation of Neurally Mediated (cardioneurogenic) Syncope: Rationale and Proposed Protocols, Pacing and Clinical Electrophysiology, 1991; 14:1528-1534.
A new scientific statement from the cardiology community on the evaluation of syncope could either win nods of acceptance or raise eyebrows with its support for echocardiograms and stress tests and its caution against tilt table testing.
The statement lays out a diminished role, however, for tilt table testing, saying that "serious questions about the sensitivity, specificity, diagnostic yield, and day-to-day reproducibility of tilt table testing exist.
Tilt table testing has traditionally been used as an aid in establishing the diagnosis of neurocardiogenic syncope, and according to lead author Dr.
The other half were randomized to the syncope unit, where they underwent up to 6 hours of continuous heart rhythm monitoring along with hourly orthostatic blood pressure measurements, an echocardiographic exam, carotid sinus massage with continuous blood pressure and heart rate monitoring, tilt table testing, and an electrophysiology consultation.