What is a tilt test?

Mohamed Djelmami Hani, MD
Cardiology (Cardiovascular Disease)
Head-up tilt testing is a way to safely diagnose neurocardiogenic syncope (also called  vasovagal syncope or the common faint) by deliberately causing the symptoms of neurocardiogenic syncope in a special room called an electrophysiology lab (EP lab).
A tilt table test is used to help determine the cause of lightheadedness or fainting, also known as syncope. It is usually done if you have had repeated, unexplained episodes of fainting, but your doctor may order a tilt table test after a single episode if you are at high risk for injury because of your occupation or other factors.
The tilt table test is intended to trigger physical responses in your body similar to those causing you to faint. During the test, you lie on a table with straps around your chest and legs. The table is then tilted into an almost upright position. You may stay upright for only a few minutes or for as long as 45 minutes, depending on how you react to the test and what your doctor suspects to be the cause of your fainting.
Your blood pressure, heart rate and heart rhythm are monitored throughout the test. How your blood pressure and pulse respond, whether you faint or feel dizzy, and the timing of symptoms will give your doctor important information about the possible cause of your fainting.

Syncope is the temporary loss of consciousness sometimes called fainting or 'passing out'. It is a common medical problem, affecting more than 3% of people in the United States and more than 6% of those over the age of 75 years. Most often, syncope is simply the result of a drop in blood pressure resulting from normal reflexes being triggered in an inappropriate or untimely fashion (called 'vasovagal' or 'neurally-mediated cardiogenic' syncope). However, some cases of syncope are due to more serious and even life-threatening conditions. The appropriate and complete evaluation and management of syncope can be critical.

Tilt Table Testing is one of the diagnostic tools used by physicians to evaluate the cause of syncope. This non-invasive test involves the patient lying flat and secured on a table and being tilted upright to a near-standing position with continuous ECG and blood pressure monitoring. In some patients, this simple maneuver will confirm the triggering of certain cardiovascular reflexes and diagnose the cause of syncope.

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