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Tilt Table Testing

By

Thomas Cascino

, MD, MSc, Michigan Medicine, University of Michigan;


Michael J. Shea

, MD, Michigan Medicine at the University of Michigan

Reviewed/Revised Dec 2023
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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 Syncope Syncope is a sudden, brief loss of consciousness with loss of postural tone followed by spontaneous revival. The patient is motionless and limp and usually has cool extremities, a weak pulse... read more and reproduce the symptoms and signs that accompany it (nausea, light-headedness, pallor, hypotension, bradycardia). Tilt table testing is also used to evaluate patients with unexplained light-headedness or dizziness and recurrent falls. Sometimes tilt table testing is used to distinguish physiologic from psychogenic syncope or syncope from some types of epilepsy.

Procedure for Tilt Table Testing

Interpretation of Tilt Table Testing

If vasovagal symptoms develop, vasovagal syncope is confirmed. If symptoms do not occur, a medication (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 blood pressure (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/minute) with little change in BP (postural orthostatic tachycardia syndrome), and report of syncope with no hemodynamic changes (psychogenic syncope).

Drugs Mentioned In This Article

Drug Name Select Trade
Isuprel
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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