What Is a Tilt Table Test?

A tilt table test is a non-invasive medical test used to evaluate unexplained fainting (syncope), dizziness, or rapid heartbeat (tachycardia).

The test involves changing a person's positioning to see how their heart rate and blood pressure respond. A positive tilt table test result can indicate autonomic dysfunction, postural orthostatic tachycardia syndrome (POTS), or a similar condition.

This article discusses the tilt table test. It explains what it is, how to prepare for it, and what the results can mean.

Why Would You Need a Tilt Table Test?

The tilt table test evaluates your blood pressure and heart rate as your position changes. It starts with lying flat in the prone position on the table. The table is tilted to a standing position as your vital signs are monitored.

A tilt table study is used to identify the cause of unexplained symptoms such as:

• Dizziness
  
• Fainting spells
• Falls
• Lightheadedness

The test aims to replicate your symptoms so your healthcare provider can get a better sense of the circumstances under which you have these experiences.

A positive tilt table test means your blood pressure or heart rate changes significantly and can indicate an underlying condition.

What a Tilt Table Test Looks For

When you stand up, your cardiovascular system adjusts to prevent too much of your blood from pooling into your legs. This causes a mild increase in heart rate and a constriction (narrowing) of the blood vessels in your legs.

Under normal circumstances, these adjustments occur very quickly and are barely noticeable.

However, in certain health conditions, postural changes can cause a significant fluctuation in blood pressure or heart rate. These include:

• Dysautonomia: A malfunctioning of nerves that regulate involuntary functions such as heart rate, breathing, blood pressure, digestion, and sweating
• Orthostatic hypotension: A form of dysautonomia that causes an excessive drop in blood pressure when you stand up
• Postural orthostatic tachycardia syndrome (POTS): A type of dysautonomia that causes your heart rate to rise dramatically upon standing
• Vasovagal syncope: A dramatic fall in blood pressure due to the vasomotor reflex, which causes sudden dilation of the blood vessels in the legs and a slowing of the heart rate
  

How Is a Tilt Table Test Performed?

The test requires a special table that can be tilted to different angles and is usually done in an outpatient suite or hospital.

You lie down on the tilt table, and your healthcare provider will secure you to the table with straps to maintain your position when the table is tilted. You will also be connected to the following:

• A blood pressure cuff on your arm
• EKG leads on your chest
• Pulse oximeter on the tip of your finger

Throughout the test, your team will monitor your blood pressure, heart rate, and oxygen levels, and ask about your symptoms.

You may be given medication such as nitroglycerin or Isuprel (isoproterenol), which speeds the heart rate, making symptoms more noticeable.

To start, the team will assess your vital signs while you are lying flat. Then the table will be mechanically tilted to an upright position. Because you are secured, this requires no effort from you.

You may be monitored at different angles for 10 to 15 minutes and assessed in a motionless standing position for 10 to 60 minutes.

How Long Is a Tilt Table Test?

The tile table test takes about an hour. However, the entire process—from check-in to release—can take a few hours.

After the test, some people may feel dizzy or lightheaded, while others may recover right away.

It is almost impossible to predict how long the positional changes or medications will affect you, so it is best to anticipate a two- to three-hour recovery time when the test is done.

You should also plan to have someone drive you home after the test.

How Uncomfortable Is a Tilt Table Test?

A tilt table test is not painful but can be uncomfortable to stay in one position for the duration of the test.

Since the test is aimed at simulating your symptoms, you may experience the following during the tilt table test:

• Dizziness
• Loss of consciousness
• Nausea
• Vomiting

You will be monitored throughout the test. If you pass out during a tilt table test, the test administrator provider will likely give you medication or adjust the angle of the table so you are lying down again.

If you experience other uncomfortable symptoms, tell your medical team. They can administer treatment or change the tilt of the table to relieve physiological changes.

How to Prepare for the Test

If you take any medications that alter your heart rate or blood pressure, your healthcare provider will let you know when or if you need to stop taking them before the test.

Do not eat or drink for three to four hours before the test. This is because it may induce nausea.

Your insurance may require pre-authorization for a tilt table test. Your healthcare provider's office should be able to help you navigate the process.

Contraindications

A tilt table test should not be performed on people with the following:

• A serious heart condition
• Severely low blood pressure

Not only will these conditions predispose you to a high chance of fainting, but there is little chance that the test could provide healthcare providers with additional useful information if you already know that you have these conditions.

After the Test

You may experience mild dizziness within the first 24 hours after your test, which should resolve when you lie down and rest. If symptoms persist for longer than a day, call your healthcare provider.

The following are not expected outcomes of a tilt table test. Seek urgent medical attention if you experience the following:

• Chest pain
• Feeling more lightheaded than usual
• Seizures
• Vision changes
  

What Do the Results Mean?

The tilt table test provides information that your healthcare providers can use as part of making a diagnosis, but the test itself does not provide any definitive answers. It may take a few days for the test results to be available.

A negative tilt table test means that you experience a minor drop in blood pressure and a slight increase in heart rate when moving from sitting to standing, which is within normal ranges.

A positive tilt table test means that you experience a significant or abnormal change in heart rate or blood pressure that warrants further investigation. For example:

• A markedly increased pulse and precipitously dropped blood pressure upon shifting to the upright position may indicate orthostatic hypotension.
• If you have vasovagal syncope and experience symptoms during the test, you likely adjusted normally to an upright tilt but may have a sudden and marked change in your vital signs (with a dramatic drop in blood pressure and pulse) within 20 to 30 minutes after the position change.

Summary

A tilt table test is a non-invasive procedure that is used to assess the cause of fainting, dizziness, lightheadedness, or unexplained falls. 

The test uses a special table that tilts to evaluate how your heart rate and blood pressure fluctuate upon moving upright. 

While some variations are normal, significant changes can indicate dysautonomia, orthostatic hypotension, POTS, or vasovagal syncope.