Tilt Table Test

[lancewhit]

Can anyone comment on the validity of tilt table testing when giving the patient something like nitroglycerine?

After passing out a year ago, I've suffered from symptoms of lightheadedness, heat sensitivity, flushing, sleep disorders, abnormal sweating, hypersensitivity, heart palpitations, and several other symptoms intermittently.

I had a tilt table test recently. During the initial tilting phase, I was not symptomatic. During the second phase, the doctor gave me a small dosage of nitroglycerine, which I've read is standard procedure with this test among lots of doctors to increase your adrenaline. At that point, I became very symptomatic--sweating, extreme lightheadedness, dizziness, nausea, shaking. BP and heart rate both went down. It took me a couple of hours after the test before I felt better.

The doctor who did the test felt I may have POTS, another doctor who reviewed the test results felt I may have NMH, and a third doctor seemed to be dismissive of the results, although he agreed that I do have some type of tendency toward syncope.

My question: what might it indicate when you're symptomatic during a tilt table only after getting something that increases your adrenaline?

I seem to be symptomatic typically in warm environments. Heat sensitivity is the key symptom and trigger for me. Just standing in place for a long time doesn't necessarily trigger my symptoms, but if I'm in a warm environment, then that's when I experience strong symptoms.

Has anyone else had a similar reaction to a tilt table test, or similar symptoms? I'm curious to hear from other people about this.

Thanks for your feedback.

[MomtoGiuliana]

Sorry you haven't gotten any replies yet. I don't know the answer to your question. However, it is possible to "pass" a tilt table test and yet still have POTS. This is b/c POTS can be so variable from day to day in intensity/symptoms--I suppose it is also variable from moment to moment, and certainly under different environmental conditions, our symptoms can also vary. It is confusing to get three different diagnoses. Who were these doctors? Any of them specialists in dysautonomia? I would recommend finding a specialist to get an answer to your question and to start any treatment, if warranted.

Good luck, Katherine

[Gena]

Sorry to hear about your frustration with the TTT and the docs. I agree that you should find a specialist in dysautonomia. In the mean time, try increasing your fluids and salt intake to see if that helps your symptoms at all. You also may want to try drinking an electrolyte drink like Gatorade in addition to your water. Heat can definitely trigger dysautonomia symptoms - so limit your time in the heat if possible. If you have a BP and HR monitor at home, you may also want to record some measurements while your lying down and standing up and throughout the day to show your doctor. Keep us posted and good luck.

[Ernie]

Hi,

At first glance it looks like you had a positive TT but it would useful to have the BP and HR numbers supine and standing when you are symptomatic.

I would go to a specialist to interpret the test result properly and to get proper treatment.

Ernie

[lancewhit]

Thanks for your responses. This may be a tough one. I did see three so-called experts--all neurologists. The neurologist who did the test seemed a bit uncertain, though he thought I may have POTS. His only advice was to drink fluids and add sallt to my diet. That didn't help much; all it did was increase my resting BP, which concerned my primary doctor who didn't want me to become hypertensive.

The second doctor was more sure of himself and declared that I have NMH. He put me on a beta blocker (Inderal) which gave me extreme sleep disorders as a side effect (while on the drug, I could hardly sleep at all; once I stopped it, my sleep eventually got better). After I told him about my reaction to the drug, he got mad at me and said he couldn't treat me any further if I was so sensitive to medication. (I've read that hypersensitivity to medication is one symptom of people with dysautonomic conditions, so I'm not sure why this doctor was so shocked and upset at me by my reaction.)

The third doctor seemed to dismiss the results of the test, I assume because I was symptomatic only with the use of the nitroglycerine, and concluded that I must be psychosomatic. (I'm not sure why some doctors jump to the conclusion that their patients are psychosomatic based on little more than their own rash judgements).

I'm still searching for yet another doctor who can help. This has been one of the toughest things about having these symptoms--trying to get more than one doctor to agree on a diagnosis and treatment, trying to be taken seriously by doctors, being treated in an arrogant or angry or dismissive way by doctors. Sometimes the doctors are worse than the symptoms.

I'm now working with a local neurologist who fortunately has the patience and kindness and professionalism that some of the other doctors seem to lack. He's taking my symptoms seriously and believes I have some dysautonomic condition. But this doctor is not an expert in dysautonomia. So I feel I have to keep searching for someone who can correctly diagnose me and find the right treatment that will help me without creating major side effects. I guess that's the challenge we all face.