Head Up Tilt Test

Head Up Tilt Test

What is a tilt table test?

A tilt table test is a non-invasive diagnostic test to determine whether your symptoms: dizziness, light headedness or loss of consciousness; are due to changes in the blood pressure and / or heart rate. At the beginning of the test, you will be asked to lie flat on a table. Two straps are put around your body to hold you in place. After about 10 – 15 minutes of lying flat, the table is then slowly tilted to raise your body to a head-up position – simulating a change in position from lying down to standing up. The table will then remain upright for either a maximum of 9 or 45 minutes (maximum time depends on the test requested by the doctor), while your heart rate and blood pressure are monitored continuously. This allows doctors to evaluate your body’s cardiovascular response to change in position.

Head Up Tilt Test

How do I prepare for the test?

Please do not eat for 4 hours prior to testing. You may drink water only in the lead up to the test. Please do not drink alcohol & do not carry out heavy exercise 12 hours prior to your appointment.

Please wear loose fitting clothing on the day of your appointment. We recommend a loose fitting T-shirt and loose fitting trousers or shorts.

What equipment will be used during the test?

For the test, you lie down on a bed that can be moved from a horizontal to a vertical position. The bed has a footrest and safety belts. A Clinical Autonomic Scientist will do the following to prepare you for the test:

Electrodes will be placed on your chest, legs and arms. The electrodes are connected by wires to an electrocardiogram (ECG) machine that monitors your heart rate during testing.

 A mini finger cuff will be attached to one of your finger and a larger blood cuff is fitted to the upper part of the same arm to continuously measure the beat to beat changes in your blood pressure during testing.

 A disposable blood pressure cuffs fitted one of your arms (usually the right arm) to do periodic checks of your blood pressure during testing.

Two safety belts will be fitted over you (one over the knees and one over the waist). The belts are placed around your body during the test to help ensure that you don’t slip off the bed.

How will I feel during the test?

The test has been request by the doctor to see if we can unmask your typical symptoms experienced in day to day life. Each tilt is different and you may or may not experience symptoms during testing. Do not worry if you do not have any symptoms during testing as we are still able to assess autonomic function during testing.

You may experience symptoms of Orthostatic Intolerance (OI), pre-syncope or syncope during the tilt. Typical symptoms include, but are not limited to; dizziness, palpitations, nausea, blurred vision and / or episodes of syncope. You are able to terminate the tilt test at any time by informing the Clinical Autonomic Scientist (CAS) performing the test. The tilt test may be terminated early by the CAS if they observe any marked falls in BP and / or HR that could be suggestive of imminent syncope. If you do have an episode that results in loss of consciousness, the CAS will return you to either a horizontal position or head down position. You will be monitored until fully recovered. Full recovery of symptoms is usually instantaneous upon returning to a horizontal position. Continuous monitoring of BP and HR will occur until resting levels have stabilised.

Testing is normally carried out as an outpatient and you should be able to return to your normal daily routine after testing.

Will you use a spray or inject any medication during the tilt test?

We do not use a spray (GTN) under the tongue or inject any medication via an IV during the tilt test. A quick blood sample may be taken whilst you are on the tilt, in order to determine the plasma catecholamine levels whilst in a standing position. The main aim of the tilt test is to determine whether prolonged standing has any effects on your blood pressure or heart rate.

What are the risks?

A tilt table test is generally safe, and complications are rare. But, as with any medical procedure, it does carry some risks. All patients will be asked to fill out a pre-assessment questionnaire, which will further assess an individual’s risk factors. If any known risk factors are highlighted, the test will be modified to minimise the risk. Potential risks include: prolonged low blood pressure and / or prolonged pause between heartbeats (asystole). These complications usually go away when the table is returned to a horizontal position.

There is very limited research on the effects and risks associated with tilt table testing & pregnancy. If you are pregnant or suspect that you may be pregnant, please notify the member of staff obtaining consent.

Who should not have a tilt test?

The tilt test should not be performed under the following circumstances: weigh greater than 45 stone / 285 kgs, had a recent (in the last 6 months) myocardial infarction or stroke /TIA, a known tight stenosis anywhere (eg heart valve, LV outflow obstruction, coronary or carotid / cerebrovascular artery)

What happens if I have questions?

If you have any questions or concerns, please ask the clinical autonomic scientist before signing the consent form for the procedure. If you are not happy to proceed with the test, please inform a member of the testing team. Even after signing the consent form, you may withdraw your consent at any time during the test.

When will I get my results from the test?

We are unable to provide results of the test on the day of your appointment. All results will be sent to Professor Mathias. You will need to arrange a follow up appointment with Professor Mathias to discuss the results of the test(s). Please email autonomic.consulting@gmail.com to arrange the appointment.