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Tilt Table Testing

Tilt table testing is used to diagnose the cause of unexplained fainting (syncope). The test helps to identify whether fainting is due to a condition called vasovagal syncope, which is related to changes in blood pressure and heart rate.

1. Procedure for Tilt Table Testing:

1.1 Preparation:

  • The subject should fast for at least 2-4 hours before the test.
  • Avoid caffeine and nicotine on the day of the test.
  • Wear comfortable clothing.

1.2 Baseline Measurements:

  • Place the subject on the tilt table in a supine (lying down) position.
  • Attach monitors to measure heart rate, blood pressure, and oxygen saturation.
  • Record baseline heart rate and blood pressure.

1.3 Initial Tilt:

  • Tilt the table to an angle of 60-70 degrees, simulating the standing position.
  • The subject should remain in this position for 20-45 minutes, depending on the protocol.
  • Monitor and record heart rate and blood pressure continuously.

1.4 Provocative Phase:

  • If there are no significant changes during the initial tilt, a pharmacological agent (such as isoproterenol or nitroglycerin) may be administered to provoke a response.
  • Continue monitoring heart rate and blood pressure.

1.5 Return to Supine Position:

  • Gradually return the table to the supine position.
  • Continue to monitor and record heart rate and blood pressure until they return to baseline levels.

2. Interpretation of Results:

2.1 Normal Response:

  • Slight increase in heart rate and stable blood pressure.
  • No significant symptoms of dizziness or fainting.

Tilt Table Testing

2.2 Abnormal Responses:

2.2.1 Vasovagal Syncope:

  • Heart Rate:Sudden drop or bradycardia.
  • Blood Pressure:Significant drop, leading to hypotension.
  • Symptoms:Dizziness, nausea, sweating, pallor, and fainting.
  • Interpretation:Positive test if syncope or presyncope symptoms are reproduced along with hypotension and/or bradycardia.

2.2.2 Postural Orthostatic Tachycardia Syndrome (POTS):

  • Heart Rate:Increase of 30 beats per minute or more within 10 minutes of tilting.
  • Blood Pressure:Generally stable, but may have slight fluctuations.
  • Symptoms:Lightheadedness, palpitations, and fatigue.
  • Interpretation:Positive test if heart rate criteria are met without significant hypotension.

2.2.3 Orthostatic Hypotension:

  • Heart Rate:May remain stable or increase slightly.
  • Blood Pressure:Systolic drop of 20 mmHg or more, or diastolic drop of 10 mmHg or more within 3 minutes of tilting.
  • Symptoms:Dizziness, blurred vision, and fainting.
  • Interpretation:Positive test if blood pressure criteria are met.

3. Safety Precautions:

  • Ensure continuous monitoring of the subject’s vital signs throughout the test.
  • Have emergency resuscitation equipment and trained personnel available.
  • Stop the test immediately if the subject experiences severe symptoms or if there are any signs of significant distress.

4. Example Graph Interpretation:

Here is an example of how to interpret a typical tilt table test graph. This graph includes heart rate and blood pressure plotted against time:

  • Initial Supine Phase:
    • Heart rate: 60-70 bpm
    • Blood pressure: 120/80 mmHg
  • During Tilt:
    • Heart rate increases gradually to 80-90 bpm.
    • Blood pressure remains relatively stable initially.
  • Abnormal Response Phase:
    • At around 10-15 minutes, heart rate suddenly drops to 50 bpm (bradycardia).
    • Blood pressure drops significantly to 90/60 mmHg (hypotension).
    • Subject experiences dizziness and fainting.
  • Return to Supine:
    • Heart rate and blood pressure gradually return to baseline.
    • Symptoms resolve.
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