Need a Tilt Table Test? Here’s What to Expect

If your doctor recommended you undergo a tilt table test, you may wonder what to expect. This guide will help you learn more about:

• What a tilt table test is

• When a doctor may recommend a tilt table test

• How to prepare for a tilt table test

• What to expect when you go in for your test

• What the test results mean

A tilt table test is a noninvasive medical procedure used to investigate the cause of unexplained syncope (or fainting spells). Through a series of tilting maneuvers, the test can help doctors understand how your body responds to changes in position, particularly how your blood pressure and heart rate react when you move from lying down to standing up. 

The test is done using a special table that tilts you from a lying position to an upright one (usually between 60 and 70 degrees above horizontal), mimicking the action of standing up. The goal is to determine if there are issues with your body’s ability to regulate blood pressure and heart rate, which can cause fainting or dizziness.

Doctors usually recommend a tilt table test if you experience unexplained fainting spells or severe dizziness that cannot be explained by common etiologies, such as electrolyte disturbances, structural heart disease, cardiac arrhythmias or cerebrovascular diseases.

These symptoms might be related to a condition called vasovagal syncope, where your heart rate and blood pressure suddenly drop after a specific trigger, causing you to faint. The test helps to pinpoint whether this is the cause of your fainting spells or if there might be another issue with how your body controls blood flow and heart function.

Some of the triggers that might clue your doctor into recommending this test include a history of fainting during stressful situations, after prolonged standing or after exposure to certain triggers like pain or the sight of blood. The tilt table test can help determine if these episodes are related to a problem with your autonomic nervous system, which controls involuntary actions like heart rate and blood pressure.

Preparing for a tilt table test is straightforward. Your doctor may ask you to fast for 4-8 hours before the test, meaning you should avoid eating or drinking, especially caffeinated beverages, for a certain period, which helps ensure accurate results.

If you take any medications, your doctor might advise you to skip certain doses, particularly those that affect your blood pressure or heart rate, but never stop taking medication without your doctor’s approval.

It’s also a good idea to wear comfortable clothing on the day of the test, as you’ll be lying down and then tilted upright. You may be asked to bring someone along who can drive you home after the test, as it’s possible to feel a bit lightheaded or tired afterward.

When you arrive for your tilt table test, you’ll be taken to a special room where the test will be conducted. The procedure usually lasts about 30 to 60 minutes, though it can sometimes take longer if additional monitoring is needed.

1. Preparation: First, you’ll lie down on the tilt table, which looks like a regular examination table but with straps to keep you secure. The staff will attach monitors to your chest and fingers to track your heart rate and blood pressure. They may also place an intravenous (IV) line in your arm in case medication needs to be given during the test.

2. Initial monitoring: You’ll start by lying flat on the table while the team records your baseline heart rate and blood pressure. This step usually lasts about 5 to 10 minutes.

3. Tilting: The table will then slowly tilt to an upright position, typically about 60 to 70 degrees, simulating standing up. You’ll stay in this position for about 20 to 45 minutes, during which the team will closely monitor how your heart and blood pressure respond.

4. Possible medication: If there’s no significant change in your heart rate or blood pressure, the doctor might give you medication through the IV to stimulate a response, making it easier to diagnose the issue.

5. Returning to flat: After the test, the table will be gently tilted back to a flat position, and you’ll rest for a few minutes while your body readjusts.

The results of the tilt table test help your doctor understand how your body regulates blood pressure and heart rate when you change positions. There are a few possible outcomes.

• Normal response: If your blood pressure and heart rate adjust normally without causing symptoms, it might suggest that your fainting spells are not related to a problem with your autonomic nervous system.

• Abnormal response: If the test triggers symptoms like dizziness, lightheadedness, or fainting, and these are accompanied by significant drops in blood pressure or heart rate, it could indicate conditions like vasovagal syncope or orthostatic hypotension. This helps your doctor plan appropriate treatments, which might include lifestyle changes, medications or further testing.

• No response with medication: If you do not have a significant response even after medication is administered, your doctor may need to consider other causes for your symptoms.

As a cardiology fellow at Montefiore Medical Center, I find that a tilt table test is a valuable tool for diagnosing the cause of unexplained fainting or dizziness. By understanding how your body reacts to changes in position, doctors can pinpoint the underlying issue and recommend the most appropriate course of action to help manage your symptoms. If your doctor suggests this test, remember that it’s a straightforward procedure with minimal preparation, and it provides essential insights into your health.

For more information on cardiovascular diseases, check out these additional resources:

Pulmonary Embolism: What It Is, Risk Factors, Symptoms, Types & Treatment

A Guide to Electrocardiogram (EKG) Testing: What to Expect

What to Know About the Different Types of Bradycardia

The Bradycardia Symptoms Everyone Should Know