Tilt-Table Test

What is a tilt-table test?

If you often feel faint or lightheaded, your health care team may use a tilt-table test to find out why. During the test, you lie on a table that is slowly tilted upward. The test measures how your blood pressure and heart rate respond to the force of gravity. A nurse or technician keeps track of your blood pressure and your heart rate (pulse) to see how they change during the test.

Why do people have tilt-table tests?

This test is used to trigger your symptoms while your health care team is watching. They measure your blood pressure and heart rate during the test to find out what’s causing your symptoms. The test is normal if your average blood pressure stays stable as the table tilts upward and your heart rate increases normally.

If your blood pressure drops and stays low during the test, you may faint or feel lightheaded. This can happen either with an abnormally slow heart rate or with a fast heart rate. That’s because your brain isn’t getting enough blood for the moment. (This is corrected as soon as you are tilted back to the flat position.) Your heart rate may not adapt as the table tilts upward, or your blood vessels may not squeeze hard enough to support your blood pressure.

There are many possible causes of feeling lightheaded or fainting (syncope), including:

• Valvular disease
• Cardiomyopathy
• Cardiac tumors
• Pulmonary embolism
• Irregular heartbeat
• Strong emotions
• Carotid sinus pressure
• Severe allergic reaction
• Anemia
• Migraine
• Prolonged standing
• Hyperventilation
• Low blood sugar (hypoglycemia)
• Some medications, including beta blockers, calcium channel blockers, diuretics, nitrates and antidepressants

Are there risks with tilt-table tests?

The tilt-table test is generally a safe procedure. People rarely faint during the test. If you do faint, medical staff will be present, and it’s safer than fainting on your own in an uncontrolled situation. If a person faints, they usually feel well again shortly after the table returns to a flat position.

How do I prepare for a tilt-table test?

• Don’t eat or drink for at least four hours before the test.
• If you are having a morning test, you may be told not to eat or drink after midnight the night before.
• If you take medication, ask if you should take it on your regular schedule before the test.

What happens during a tilt-table test?

A specially trained nurse or technician performs the tilt-table test in a hospital or clinic electrophysiology lab. The test has two parts.

Part One

The first part of the test shows how your body responds when you change positions.

• You lie on your back on a table. Straps at your waist and knees help you stay in position. An IV is put in your arm.  Small pads with wires are attached to your chest and are connected to an electrocardiograph (EKG) machine to track your heartbeat. A cuff on your arm measures your blood pressure.
• The table is tilted so your head is slightly higher (30 degrees) than the rest of your body while your blood pressure and heart rate are checked.
• After two to three minutes, the table will move to a 45-degree tilt.
• After another two to three minutes, the table is tilted to a 70-degree angle. You will remain in this position for up to 45 minutes while your blood pressure and heart rate are checked. You will be asked to stay still and quiet during this time, but you should tell someone if you feel uncomfortable.
• If your blood pressure drops during this time, the table will be lowered and the test will stop. You won’t need to take the second part of the test. If your blood pressure does not drop after the time is up, the table will be lowered again and the second part of the test will start.

Part Two

The second part of the test shows how your body responds to a medication that causes your heart to beat faster and stronger. This medication is like the hormone adrenaline that your body releases when you are under stress. It may make you feel like you are exercising. It may make you more sensitive to the tilt-table test if your blood pressure didn’t change during the first part of the test. For this part of the test:

• You will be given medication through your IV, a pill or spray.
• Next, the table is tilted upward to a 60-degree angle.
• You may feel your heartbeat increase because of the medication.
• If your blood pressure drops, the table will be lowered to the flat position, the medication will be stopped, and the test will end.
• If your blood pressure does not drop after about 15 minutes, the table will be lowered, and the test will be over.

The tilt-table test lasts about an hour if you do both parts. If you do only the first part, you may be done in 20-45 minutes.

What happens after a tilt-table test?

You may feel tired and a little sick to your stomach right after the test. After recovery, most people can drive home and return to their normal activities. However, if you lose consciousness during the test, you may need more observation and testing. Don’t drive yourself home if you fainted.

How do I learn about my results?

You may get your results as soon as the test is over. Sometimes, your health care professional will give you the results a few days later. The results are either negative or positive.

• If your blood pressure does not fall significantly during the test, you don’t faint and your heart rate increases only slightly, the test results are negative (normal).
• If your blood pressure drops, your heart rate changes and you feel faint or dizzy during the test, the test is positive. Your health care professional may suggest changing your medications or having more tests. If your fainting is due to a slow heart rate (bradycardia), a pacemaker may be recommended.