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Tilt Table Testing

By Michael J. Shea, MD, University of Michigan Health Systems

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Tilt table testing is used to evaluate syncope in

  • Younger, apparently healthy patients

  • Elderly patients when cardiac and other tests have not provided a diagnosis

Tilt table testing produces maximal venous pooling, which can trigger vasovagal (neurocardiogenic) syncope and reproduce the symptoms and signs that accompany it (nausea, light-headedness, pallor, hypotension, bradycardia).


After an overnight fast, a patient is placed on a motorized table with a foot board at one end and is held in place by a single strap over the stomach; an IV line is inserted. After the patient remains supine for 15 min, the table is tilted nearly upright to 60 to 80° for 45 min during which symptoms and vital signs are monitored.


Relative contraindications include

  • Severe aortic valve stenosis

  • Severe mitral valve stenosis

  • Hypertrophic cardiomyopathy

  • Severe coronary artery disease


If vasovagal symptoms develop, vasovagal syncope is confirmed. If they do not occur, a drug (eg, isoproterenol) may be given to induce them. NOTE: isoproterenol should not be used in patients with hypertrophic cardiomyopathy or severe coronary artery disease.Sensitivity varies from 30 to 80% depending on the protocol used. The false-positive rate is 10 to 15%.

With vasovagal syncope, heart rate and BP usually decrease. Some patients have only a decrease in heart rate (cardioinhibitory); others have only a decrease in BP (vasodepressor). Other responses that suggest alternative diagnoses include a gradual decrease in systolic and diastolic BP with little change in heart rate (dysautonomic pattern), significant increase in heart rate (> 30 beats/min) with little change in BP (postural orthostatic tachycardia syndrome), and report of syncope with no hemodynamic changes (psychogenic syncope).

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