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Tilt Testing

A tilt table test is a test used to evaluate and diagnose a syndrome called neurocardiogenic syncope, a common cause of lightheaded spells or fainting or passing out spells which can occur in otherwise normal individuals.  The normal heart rate and blood pressure are a balance of the hearts own intrinsic rate, the body’s sympathetic tone (adrenaline levels), and the body’s vagal tone.  The sympathetic tone increases the heart rate and blood pressure, as what happens during exercise.  The vagus nerve is activated by the brain and slows the heart and reduces the blood pressure and can be activated by many things. 

Certain individuals have an abnormality in the body’s reflex control of the heart rate so that the balance between the sympathetic tone (adrenaline) and parasympathetic tone (vagus nerve) becomes abnormal leading to either an abnormally low heart rate or an abnormally low blood pressure.  These events can occur at rest, with prolonged sitting or standing, dehydration, and sometimes without known causes and can cause sudden lightheadedness or fainting.  The episodes resolve on their own but can be worrisome or accompanied by trauma. 

The tilt table test is designed to replicate this syndrome.  Patients are placed on a table, secured so that they are still, and the table is then tilted to 70 to 80 degrees with the head up and observed, monitoring the heart rate and the blood pressure.  Nitroglycerin or Isoproterenol can be given to help elucidate the abnormal reflex.  Patients are generally tilted for between 15 and 30 minutes.  A positive test consists of a lightheaded spell or fainting spell accompanied by a low heart rate or blood pressure.  If the test is positive the table is returned to horizontal and the blood pressure, heart rate quickly normalize. 

The tilt test is generally used in patients who have had episodes of lightheadedness or fainting spells in whom it is not certain as to the cause.  A positive tilt suggests the syndrome may be a neurocardiogenic syndrome.  Treatment is generally fluids and salt to maintain blood pressure, exercise, recognition of the syndrome, and certain medication, and rarely pacemakers.

       

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