tilttable

A tilt table test, or tilt-table testing, is a diagnostic procedure used to evaluate causes of transient loss of consciousness and fainting that occur after standing. The test assesses the body's cardiovascular response to a controlled change in posture, typically from horizontal to upright, to help distinguish vasovagal syncope and other forms of orthostatic intolerance from cardiac or neurological causes.

During the test, the patient lies on a motorized table and is connected to monitoring equipment for heart rate, blood pressure, and often oxygen saturation and electrocardiography. After a brief resting period, the table is tilted to an angle usually between 60 and 70 degrees and maintained for about 20 to 45 minutes, with the patient reporting any symptoms. If no provocative response occurs, pharmacologic agents such as isoproterenol or nitroglycerin may be used to increase the likelihood of eliciting a response.

Indications for tilt-table testing include unexplained or recurrent syncope, suspected neurally mediated hypotension, and evaluation of orthostatic intolerance when other tests are inconclusive. A positive result typically involves reproducible presyncope or syncope accompanied by characteristic drops in blood pressure and/or heart rate. A negative result does not completely exclude vasovagal syncope, particularly if the protocol or patient factors are suboptimal.

Safety and limitations: the test is generally safe but can provoke syncope or, rarely, arrhythmias or prolonged hypotension. It may be contraindicated in patients with certain cardiovascular or neurological conditions. Medications, hydration status, and anxiety can influence results, and results should be interpreted in the clinical context.

History and context: tilt-table testing is a standard component of autonomic function assessment and is performed in specialized centers by clinicians experienced in syncope management. It is used in adults and, with adaptations, in pediatric populations.