• A tilt-table test involves changing a person’s positioning quickly and seeing how their blood pressure and heart rate respond.
  • This test is ordered for people who have symptoms like a rapid heartbeat or who often feel faint when they go from a sitting to standing position. Doctors call this condition syncope.
  • Potential risks of the test include nausea, dizziness, and fainting.
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Illustration by Diego Sabogal

Doctors recommend a tilt-table test for patients they suspect may have certain medical conditions, including:

Neurally mediated hypotension

Doctors also call this condition the fainting reflex or autonomic dysfunction. It causes a person’s heart rate to slow down instead of speed up when they stand, which keeps blood from pooling in the legs and arms. As a result, a person may feel faint.

Neurally mediated syncope

A person with this syndrome can experience symptoms such as nausea, lightheadedness, and pale skin, followed by a loss of consciousness.

Postural orthostatic tachycardia syndrome (POTS)

This disorder occurs when a person experiences changes when they suddenly stand up. Doctors associate POTS with an increase in heart rate up to 30 beats and feeling faint within 10 minutes of standing up from a sitting position.

Women between the ages of 15 and 50 are more likely to experience POTS, according to the National Institute of Neurological Disorders and Stroke.

The tilt-table test can simulate the effect of sitting to standing in a controlled environment, so a doctor can see how a person’s body responds.

The purpose of the tilt-table test is for a doctor to view firsthand the symptoms you experience when changing position.

You might not feel ill effects during the procedure, but you may experience symptoms like dizziness, feeling faint, or even fainting. You may also feel very nauseated.

Follow advice on when to eat

Because some people feel nauseated when they go from a sitting to standing position, a doctor may ask you not to eat two to eight hours before the test. This helps to minimize the chance you’ll be sick to your stomach.

Talk about medications you’re taking

Your doctor will also review the medications you’re currently taking and make recommendations about which ones you should take the night before or the morning of your test. If you have a question about a particular medication, ask your doctor.

Consider if you’ll drive yourself or get a ride

You may want a person to drive you home after the procedure. Consider arranging for a ride beforehand to make sure someone is available.

The tilt table does exactly as the name suggests. It allows a medical professional to adjust the angle of the flat top while you’re lying down.

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Illustration by Diego Sabogal

When you go for a tilt-table test, here’s what you can expect:

  1. You’ll lie down on a special table, and a medical professional will attach various monitors to your body. These include a blood pressure cuff, electrocardiogram (ECG) leads, and an oxygen saturation probe. Someone might also start an intravenous (IV) line in your arm so you can receive medications, if needed.
  2. A nurse will tilt or move the table so your head is elevated about 30 degrees above the rest of your body. The nurse will check your vital signs.
  3. A nurse will continue to tilt the table upward about 60 degrees or more, essentially making you upright. They’ll repeatedly measure your blood pressure, heart rate, and oxygen levels to detect if there are any changes.
  4. If at any time your blood pressure drops too much or you feel faint, a nurse will return the table to the starting position. This will, ideally, help you feel better.
  5. If you don’t have a change in your vital signs and still feel OK after the table has moved, you’ll progress to the second part of the test. However, people who’ve already had symptoms don’t need the second part of the test to show how their vital signs change when they move in position.
  6. A nurse will administer a medication called isoproterenol (Isuprel) that’ll cause your heart to beat faster and harder. This effect is similar to that of strenuous physical activity.
  7. The nurse will repeat the tilt-table test by increasing the angle to 60 degrees. You’ll likely remain at this height for about 15 minutes to determine if you’ll have a reaction to the change in position.

The test will typically last about an hour and a half if you don’t have changes in your vital signs. If your vital signs do change or you don’t feel well during the test, a nurse will stop the test.

After the test is over, or if you feel faint during the test, a nurse and other medical professionals may move you to another bed or chair. You’ll likely be asked to remain in the facility’s recovery area for 30 to 60 minutes.

Sometimes, people feel nauseated after they finish a tilt-table test. A nurse may give you anti-nausea medications if this is the case.

Most of the time, you can drive yourself home after the test. However, if you fainted or felt faint during the test, your doctor may want you to stay overnight for observation or have someone drive you home.

What negative means

If you don’t have a reaction to the changes in the table’s positioning, doctors consider the test to be negative.

You may still have a medical condition related to position changes. This result means the test didn’t reveal changes.

Your doctor may recommend other forms of testing to monitor your heart, such as a Holter monitor you wear to track your heart rate over time.

What positive means

If your blood pressure changes during the test, the test results are positive. Your doctor’s recommendations will depend on how your body reacted.

For example, if your heart rate slows, your doctor may recommend additional tests to look at your heart. They may prescribe a medication called midodrine to prevent blood pressure drops.

If your heart rate quickens, a doctor may prescribe medications — such as fludrocortisone, indomethacin, or dihydroergotamine — to reduce the likelihood that reaction will occur.

If you do receive a positive result, additional tests may be needed to look further into the heart.

While there are several tests to measure blood pressure changes brought on by a change in position, the tilt-table test may be a more appropriate method for diagnosing older adults, according to an article in the journal Clinical Interventions in Aging.

Prior to the test, a doctor will discuss how it may aid in your diagnosis and inform you of any potential risks.

If your test was negative but you’re still having symptoms, talk to your doctor about other potential causes. They may review your medications or recommend other tests.