Tilt table examination

Dr. med. Philipp Nicol is a freelance writer for the medical editorial team.

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A tilt table examination is a medical procedure for diagnosing fainting spells (syncope). Attacks of unconsciousness can be artificially generated with a movable couch within the scope of the examination. Read everything about the tilt table examination, how it is carried out and the risks involved in the examination.

What is a tilt table exam?

A tilt table examination is usually carried out for more detailed clarification in the case of unclear fainting spells (syncope).

What is syncope?

Syncope is a sudden onset of short-term fainting. Colloquially, syncope is often referred to as circulatory collapse. Syncope is divided into different categories according to the way it develops:

• Vasovagal syncope: Triggers can be standing for a long time or emotions such as experiences of shock or pain
• Orthostatic syncope: occurs when changing to an upright position
• cardiac syncope: occurs when blood flow disorders in the brain occur
• cerebrovascular syncope: is triggered by what is known as a tap phenomenon, which can lead to an insufficient supply of blood to the brain

When do you do a tilt table examination?

Vasovagal syncope is the most common and can be diagnosed with the tilt table examination. Regardless of this, syncope must always be clarified by a doctor, because behind a circulatory collapse there can be underlying diseases that should be discovered early in order to be able to treat them effectively.

With certain pre-existing conditions, no tilt table examination may be carried out. These include:

• pronounced narrowing of the heart valves (aortic or mitral valve stenosis)
• pronounced narrowing of the coronary arteries (coronary stenosis)
• pronounced narrowing of brain vessels (cerebrovascular stenosis)

What do you do during a tilt table examination?

The doctor performs the tilt table examination on a special tilt table - a movable couch. The patient is strapped onto this table and, after a while, is brought into an upright position in a horizontal position.

Before the start of the tilt table examination, the patient is given an intravenous line for the rapid administration of medication. The blood pressure is constantly monitored and an electrocardiogram is recorded to monitor the activity of the heart. You should not eat anything about four hours before the examination.

At the beginning of the examination, blood pressure and pulse are measured for about five minutes while lying down. The patient is then brought into an upright position for 20 to 45 minutes using the tilt table at an angle of 60 to 70 degrees. In addition, drugs can be administered that cause the vessels to widen and thus lower blood pressure and can increase unclear syncope. The entire examination takes about an hour.

Positive tilt table examination

The tilt table examination is rated as positive if the blood pressure or pulse decreases in the upright position and the patient feels faint. If these symptoms occur, the test is stopped immediately and the tilting table is returned to a horizontal position.

Negative tilt table examination

If there are no fainting spells or changes in blood pressure and pulse after 45 minutes in an upright position, the test is negative.

The tilt table examination is easy to perform and is widely used. However, the examination is not very precise, because even with negative test results, the patient can suffer from syncope (false-negative result) or healthy people can have positive results in the tilt table examination (false-positive result). Therefore, further examinations are usually necessary.

What are the risks of a tilt table examination?

Complications are very rare in the tilt table examination. If you suffer from syncope, straightening up can lead to very low blood pressure (hypotension) and, in extreme cases, to brief cardiac arrest (asystole).

Usually, however, if syncope occurs, the only action required is to quickly tilt back (in less than ten seconds) to the lying position.

What do I have to consider after a tilt table examination?

If no complications occurred during the tilt table examination, you usually do not need to take any further precautionary measures after the examination.

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