A tilt table test is used if you have syncope (fainting spells) for no known reason. Cardiologists use a tilt table test to diagnose orthostatic hypotension and neurally mediated hypotension (NMH) or neurally mediated syncope (NMS). People who have NMH usually faint during this test. This test can help your cardiologist find any underlying brain or nerve conditions.

The Procedure

The patient is hooked to an EKG machine and a BP monitor. The HR and BP are constantly monitored during the procedure. An intravenous (IV) line is placed in the arm. Large patches are also applied to the patient's chest.

Patches are connected to an external pacemaker and turned on if the patient's HR slows down and does not pick right up (in the majority of cases the slow HR is transient and the external pacemaker is only a precautionary measure).

The patient lays on a swivel table, the tilt table, in a flat position. Safety straps are applied across the chest and legs to hold the patient in place.

After obtaining the baseline HR and BP, the motorized table is tilted up to an angle of 80 degrees. This simulates going from a flat (supine) to a standing or upright position. The change in position causes the HR and BP to rise and the patient's response is noted, possibly syncope. Depending upon the physician and the protocol of a given laboratory, the duration of time spent in the supine and upright position can vary from 5 to 30 minutes.

If nothing happens, the tilt table is returned to the flat position and an intravenous infusion of isoproternol (Trade name = Isuprel) is started. This medicine increases the HR and BP. This effect is similar to that produced by our own natural adrenaline release. As you may have gathered, the test is now simulating what happens when the sympathetic nervous system is stimulated and the "accelerator" is pressed. The tilt table is then raised back up to 80 degrees and the IV medication continued.