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Tilt Table Test

A tilt table test, or head-up tilt test, is a diagnostic procedure used to evaluate patients with symptoms of fainting, dizziness, or abnormal heart rhythms. 

What is a Tilt Table Test?

A tilt table test is a diagnostic procedure that assesses how your body responds to changes in position, from lying down to standing up. It is used to diagnose and evaluate a variety of conditions, including

  • Vasovagal syncope (fainting)
    Vasovagal syncope is the most common type of fainting and is caused by a sudden drop in blood pressure and heart rate.

  • Neurally mediated hypotension (NMH)
    NMH is a condition that causes blood pressure and heart rate to drop when standing up. This can lead to dizziness, lightheadedness, and fainting.

  • Autonomic dysfunction
    Autonomic dysfunction is a life-threatening condition that can occur in people with spinal cord injuries above the T6 level. It is caused by an overreaction of the autonomic nervous system in response to stimuli, such as pain or bladder fullness.

  • Pots
    A tilt table test is used to diagnose people with postural orthostatic tachycardia syndrome (POTS). In patients aged 18 and older, an increase in heart rate of 30 beats per minute during the initial five minutes of the test may be indicative of POTS.

Risks VS Benefits of a Tilt Table Test

For most patients, the benefits of identifying the cause of symptoms like fainting outweigh the minimal risks involved with a supervised tilt table test. By identifying the cause of your symptoms, your doctor can develop a treatment plan to help you prevent future episodes and improve your quality of life.

Benefits of the Tilt Table Test

  • Accurate diagnosis
    The test can definitively diagnose the cause of syncope or fainting spells based on the heart rate and blood pressure response.

  • Assess medical conditions
    It can help diagnose conditions like postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and neurally mediated syncope.

  • Evaluate medication effectiveness
    It allows evaluation of how well medications work to control heart rate and blood pressure.

  • Guide treatment
    Based on test results, appropriate treatments can be implemented like medication, cardiac pacing, or lifestyle changes.

  • Identify need for pacemaker
    For patients with reflex-induced bradycardia, the test may indicate need for a permanent pacemaker.

What to Expect Before, During, and After a Tilt Table Test

Adequate preparation is important for accurate results when undergoing a tilt table test. Be sure to inform your doctor of all medications you are taking, including prescription, over-the-counter, and herbal supplements, as some can potentially impact the results of the test. It is advisable to fast for 4-6 hours prior to the test to prevent any nausea or vomiting during the procedure. You should also avoid consumption of caffeine and alcohol for 24 hours before the tilt table test, as these substances can lead to dehydration and increase the likelihood of fainting during the procedure.


For comfort, wear loose-fitting clothing since you will be strapped securely to the tilt table for the duration of the test. During the actual test, you will start lying flat on the tilt table and then be gradually tilted to an upright position. This upright position will be maintained for up to 45 minutes or until symptoms occur, while your vital signs like blood pressure and heart rate are continuously monitored to assess your response to the change in position. Here are a few other things to keep in mind post-procedure:

  • You may feel slightly lightheaded or fatigued after the test.
  • You should hydrate adequately and eat something to help you recover.
  • You should avoid driving for the rest of the day if you experience fainting or severe symptoms.
  • You must contact your doctor if you have concerns about persistent side effects after the test.

Am I a Candidate for a Tilt Table Test?

Determining whether you are a good candidate for a tilt table test involves a careful assessment by your doctor. This diagnostic procedure is primarily used to evaluate conditions related to changes in body position, particularly orthostatic intolerance and syncope (fainting). Here are some factors that may indicate you are a candidate for the tilt table test:

  • Unexplained fainting episodes
    If you have experienced recurrent fainting episodes, especially if the cause is unknown, your doctor may recommend a tilt table test to identify potential underlying causes.

  • Orthostatic intolerance
    Symptoms like dizziness, lightheadedness, or near-fainting when transitioning from lying down or sitting to a standing position could suggest orthostatic intolerance. This condition can be assessed through the tilt table test.

  • Suspected autonomic nervous system disorders
    The test is commonly used in cases where autonomic nervous system dysfunction is suspected. Conditions such as neurocardiogenic syncope (common fainting) and postural orthostatic tachycardia syndrome (POTS) fall under this category.

  • Recurrent syncope with unclear causes
    For individuals who have experienced repeated episodes of syncope (fainting) without a clear diagnosis, the tilt table test can help pinpoint the cause and guide treatment.

  • Evaluation of medication effectiveness
    In some cases, the test may be used to assess the effectiveness of certain medications in managing syncope or orthostatic intolerance.

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