What is a tilt table test and why is it performed during the investigation of syncope?

2021 ◽  
pp. 1-7
Author(s):  
Laura White ◽  
Howell T Jones ◽  
Anne Davies
Keyword(s):  
Patient Experiences ◽  
Therapeutic Interventions ◽  
Controlled Environment ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Detailed History ◽  
Postural Tachycardia ◽  
Bedside Tests ◽  
Simple Bedside ◽  
Complex Cases

Falls are one of the most common reasons for patients to present to the emergency department. Syncope is a common cause of falls, which disproportionately affects older people. In most cases, syncope can be confirmed with a detailed history and simple bedside tests, but tilt table testing remains an invaluable diagnostic adjunct in more complex cases. Often misunderstood, the tilt table test is a useful way to reproduce a patient’s symptoms in a safe and controlled environment. The tilt table test is considered positive if the patient experiences symptoms associated with a drop in blood pressure or postural tachycardia. The test can support a diagnosis and can direct therapeutic interventions.

scholarly journals Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kenneth A. Mayuga ◽  
Natalie Ho ◽  
Robert W. Shields ◽  
Paul Cremer ◽  
L. Leonardo Rodriguez
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Vasovagal Syncope ◽  
Left Ventricular ◽  
Postural Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Septal Myectomy ◽  
Postural Tachycardia ◽  
Septal Hypertrophy

A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

scholarly journals Correlation of head-up tilt table test time interval with risk of recurrent syncope

2015 ◽  
Vol 67 ◽  
pp. S77
Author(s):  
R.K. Gokhroo ◽  
Kumari Priti ◽  
A. Avinash ◽  
Bhanwar Lal Ranwa ◽  
Kamal Kishor ◽  
...  
Keyword(s):  
Test Time ◽  
Time Interval ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Head Up Tilt

Repolarization disparity as a predictor of response to Head Up Tilt‐table Test in pediatric syncope

2021 ◽  
Author(s):  
Mohammad Reza Khalilian ◽  
Abdolrahim Ghasemi ◽  
Narges Khazaei ◽  
Sara Khoshkhou ◽  
Elham Mahmoudi
Keyword(s):  
Tilt Table Test ◽  
Tilt Table ◽  
Head Up Tilt

scholarly journals Patients with reflex syncope have a higher prevalence of atrial fibrillation than general population which is predicted by the type of the tilt table test response

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J M Farinha ◽  
L Parreira ◽  
A F Esteves ◽  
M Fonseca ◽  
A Pinheiro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
General Population ◽  
Tilt Test ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Test Response ◽  
Reflex Syncope ◽  
Vasodepressor Response

Abstract Introduction Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF). Objective The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF. Methods We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF. Results We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043). Conclusions Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF. FUNDunding Acknowledgement Type of funding sources: None.

The Use of Transcranial Doppler during Tilt Table Testing in Children Presenting with Syncope

2007 ◽  
Vol 31 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Heather A. Nicoletto ◽  
Mark W. Ellis ◽  
Daniel T. Laskowitz ◽  
Ronald J. Kanter ◽  
April E. Perry ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Psychiatric Treatment ◽  
Cerebral Arteries ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Multimodal Monitoring ◽  
Neurally Mediated Syncope ◽  
Middle Cerebral Arteries ◽  
Tilt Table Testing ◽  
Flow Velocities

Childhood syncope is common, and there are three categories of causes of syncope: noncardiovascular pseudosyncope, cardiovascular syncope, and neurally mediated syncope. Tilt table testing has become a valuable tool in the evaluation for the cause of syncope in children. Adding transcranial Doppler (TCD) to the tilt table test to monitor the middle cerebral arteries (MCA) adds valuable information about the cerebral blood flow during a syncopal episode and can help the physician differentiate between the various causes of syncope. Three children with frequent syncopal episodes were evaluated using tilt table testing with multimodal monitoring, including TCD. One child, during her syncopal episode, had an increase in blood pressure, heart rate, and MCA flow velocities. This finding was consistent with noncardiovascular pseudosyncope, and she was sent for psychiatric treatment. The other two patients had hypotension, bradycardia, a significant decrease in MCA flow velocities, and an increase in pulsatility indices. Additionally, one of them experienced a 6-sec period of asystole. Both were diagnosed with neurally mediated syncope and were placed on fludrocortisone and a water and salt regimen.

Cardiovascular Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
D A Hussein ◽  
A B E Abdelaziz ◽  
A M Abdelmoteleb ◽  
M A Elserwy ◽  
S G Arafa
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Tilt Table Test ◽  
Systemic Lupus ◽  
Tilt Table ◽  
Increased Risk

Abstract Background involvement of central and peripheral nervous systems are well-documented in SLE but literature on prevalence and pattern of autonomic neuropathy are few. Women with SLE have been found to have 5-8 fold increased risk of coronary heart disease. Autonomic dysfunction in the presence of structural cardiovascular disease is associated with adverse prognosis. Aim of the Work the purpose of this study is to evaluate the cardiovascular autonomic function in patients with Systemic lupus erythematosus, and to correlate it with SLE clinical features. Patients and Methods we conducted our study on one-hundred Egyptian SLE patients diagnosed according to SLICC classification criteria for SLE recruited from rheumatology outpatient clinic and inpatient department at Ain Shams University Hospitals. All the studied patients were subjected to history taking, clinical examination, and laboratory and radiological investigations related to SLE diagnosis and activity. SLE disease activity was assessed by SLE disease activity index-2000 (SLEDAI-2K).Tilt table test was used to assess for presence of cardiovascular autonomic neuropathy. Results we found that fifty (50%) of our SLE patients had symptoms suggestive for autonomic dysfunction, including orthostatic hypotension, palpitation and or Raynaud’s phenomenon. Regarding the result of tilt table test, sixty eight (68%) of the studied SLE patients were found to have positive tilt table responses. By doing the uni-variate analysis for predictors of SLE patients with positive tilt table test, we found that vasculitis, proteinuria, DNA, low TLC and complement levels, high SLEDAI, ESR and urinary P/C all were predictors for positivity of tilt table testing. Conclusion The prevalence of autonomic dysfunction was high among SLE patients.

scholarly journals The Differences in the Diagnostic Profile in Children with Vasovagal Syncope between the Result of Head-Up Tilt Table Test

2020 ◽  
Vol 17 (12) ◽  
pp. 4524
Author(s):  
Ewelina Kolarczyk ◽  
Lesław Szydłowski ◽  
Agnieszka Skierska ◽  
Grażyna Markiewicz-Łoskot
Keyword(s):  
Medical Records ◽  
Vasovagal Syncope ◽  
Speech Disorders ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Prodromal Symptoms ◽  
Close Relationship ◽  
Head Up Tilt ◽  
Diagnostic Profile ◽  
Positive Results

(1) Background: The features characterizing vasovagal syncope (VVS) are an important factor in the correct evaluation of diagnostic risk stratification in children and adolescents. The aim of the study was to determine the value of identifying the clinical characteristics in children with VVS. (2) Methods: We made a retrospective analysis of the medical records of 109 children with diagnosed VVS. We investigated the specific characteristics of syncope in children with VVS including the positive VVS (+) and negative VVS (−) result of the Head-Up Tilt Table Test (HUTT). (3) Results: We did not observe significant differences in the prodromal symptoms of VVS with HUTT response. In addition to typical prodromal symptoms, no difference in statistically reported palpitations (35/109 or 32.1%) and chest discomfort (27/109 or 27.7%) were recorded. Fear–pain–stress emotions as circumstances of syncope were more often reported by children with a negative HUTT (p = 0.02). Cramps–contractures (p = 0.016) and speech disorders (p = 0.038) were significantly higher in the group with negative HUTT. (4) Conclusions: There is a close relationship in the diagnostic profile between the negative and positive results of head-up tilt table test in children with vasovagal syncope.

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