Tilt Table Questions

[Michelle F.]

I mentioned some of my TTT experience on another post, but I have some questions I'd like to ask here. My neuro said that I have dysautonomia, but I don't know what form he believes I have. I also have a history of MVP. I'm learning here what questions I need to ask.

Anyway, while on the TT, I believe I maintained a bp of about 135/80 most of the first 20 minutes while lying flat. The nurse kept talking to me and asking medical questions, then had me sign my papers while hooked up to everything, so it was hard to relax and do my normal thing. Usually at home my bp drops along with my heart rate quickly after lying down.

Then, I was put in an upright position. I didn't realize that I was supposed to really simulate what I would do at home if I "let myself go", so I did what I usually do and tried not to pass out. I rested my body on the table rather than stood on the platform. I turned "what as a sheet" and my bp went to 70/40 with heart rate at 47 upon being put upright. I felt awful and my lungs especially felt heavy. It was hard to breathe, but I didn't panic. After 5 minutes with no change in BP or HR, the nurse asked me if I could continue to stay in that position for another 35 minutes. I have to admit I felt anxious when she said this. It was also then that I realized I was supposed to let myself pass out if that was what I would do at home. So, I relaxed and just let go. My breathing was shallow, but not panting. I gave her play by play verbally of how I felt...even up to the point where I said, "I'm going to cry". It felt just awful, but I didn't feel like I was having a panic attack. Needless to say, I awoke doubled over, not knowing where I was and being pulled from a super, super deep dream.

When I came to, the nurse said something like, "It's good I sat you back or you would still be out." I didn't understand this because I awoke with the table upright. She seemed a little unsettled herself. I asked her how long I was out and she said "less than a minute".

When the cardiologist, whom I've never met before, came in and looked over everything VERY briefly, the nurse told her that I was panting (don't know at what stage she meant) and that I was mumbling something that she couldn't understand when I was out. Please bear in mind that the credibility of the nurse is at question with me. I didn't feel that she had lowered the table at all, but that she acted like she might get into trouble for something...not sure what...maybe allowing me to go so far as to pass out? But, maybe she did. I was out. From the beginning she tried to talk me out of taking the test. I then realized she was unhappy she was missing meeting someone for lunch. She was also unhappy that she was being asked to perform four more tests that she did not want to do! While I was lying there recovering, another nurse came in and they both complained together. The nurse also took a personal call while I was recovering. I sure didn't feel the focus of the event.

The cardiologist said that I hyperventilated from a Dysautonomia-induced Panic Attack and I need to see a psychiatrist. She said something like, "you didn't even get far enough along to have the medicine". She prescribed a beta blocker and called my primary doctor. My primary doctor said that she seemed suspiciously overly-conscientous and he thought it might have something to do with the cardiologist being aware of the nurse goings-on. The cardio told my primary that my anxiousness needs to be addressed, but that further evaluation for the presence of any heart conditions should be done. My primary told me that the cardiologist did realize that you don't faint nerves. He also said that my feeling like I was leaving a dream sounded something like a seizure, but that I didn't have one. He said I flunked the TTT. What does that mean? Positive TTT?

I am planning to go to another cardiologist with knowledge of Dysautonomia and MVP. I'm keeping my neuro in the loop in case it turns out that I have no cardiac reasons for the pre-syncope episodes I keep having.

Any answers, help, input and knowledge about any of this that may sound familiar is greatly appreciated! I'm so glad to have found you all!

Michelle F.

[Ernie]

Hi,

Usually the doctor is suppose to be in the room when they perform a TTT until syncope. Also, they are suppose to put down the patient as soon as possible after the syncope to avoid side effects.

I am surprised that you woke up upright.

Many studies have proved that hyperventilating alone does not trigger syncope.

Hyperventilating is normal when a person is about to faint because you don't have enough blood and oxygen going to your brain.

Usually when they said that you failed the TTT it means that it is a positive TTT or that you have the disorder. It seems from the number your gave that your have NCS.

[Michelle F.]

Ernie-Thank you. I often feel I do not get enough oxygen/blood to my head. In hindsight, I believe I have been like this off and on since I was 9yo (I am now 42). When I was 9, I was in an auto accident where I broke my collarbone. I fainted with that and off and on since then. One discovery on a recent MRA of my brain is that one of the two main vertebral arteries that supplies blood to my head does not connect, but ends. The remaining vertebral artery that remains is larger to try to compensate. I am starting to believe all this goes back to that accident. Thanks again!

Michelle F.

[ajw4790]

Hi,

Welcome! It sounds like that TTT was quite an ordeal, wow! Not fun!

Interesting on the fact of symptoms appearing post car accident and the MRA results.

Did you have whiplash or any neck injury in the car accident?

I hope your next cardiologist will be of more help!!! Also, a neurologist maybe helpful as well.

[Rachel]

Hi Michelle,

I'm sorry your ttt was such an ordeal. It sounds like the nurse did not do things correctly. I'm shocked that she kept asking you medical questions and having you sign papers during the test when they were supposed to be getting a good baseline hr and bp. My goodness.

I don't know what the doctor meant by saying that you flunked the ttt. I don't know if that would mean positive, negative, or inconclusive. It is strange that the doctor said, "you didn't even get far enough along to have the medicine." Not everyone needs the iv medication (Isuprel). My ttt was positive without it, as was my sister's. There are also many other members here who didn't need it. Isuprel is used to speed up the ttt only when necessary. Some doctors prefer not to use it because it can give false positive tests.

I recommend getting a copy of your hospital records from the test, and bringing it with you to the new cardiologist. There may be enough information there for him/her to make a diagnosis.

I hope you find the answers and help you need.

All the best,

Rachel

[Michelle F.]

ajw4055- "Did you have whiplash or any neck injury in the car accident?"

I don't know if I had whiplash or not, I was 9 and don't remember much about it. It wouldn't surprise me because of the proximity of my collarbone to neck when it was fractured. I can tell you that I have had a weak neck for as long as I can remember. When I was 25 yo, I slightly tilted my head back to put on eye shadow when I heard a tremendously loud pop. I couldn't lift my arms and was in a lot of pain. I had ruptured a cervical disk to the point of leaking, but not completely. I was in traction for six weeks and recovered without surgery. Still, I have a weak neck and I hear grinding and fluid sounds in it. I have a neurologist that I have been seeing since 2006. It seems the time to get a second opinion. Thank you for responding!

Rachel- "I recommend getting a copy of your hospital records from the test, and bringing it with you to the new cardiologist. There may be enough information there for him/her to make a diagnosis."

I will be seeing another cardiologist on 8/7 and I will be sure to take the hospital records. Thank you!!