Tilt Table Test Results, Please Help!

[Purple]

I'm confused, as this is all new to me. Does this seem like POTS? My cardiologist ordered the test because he suspected I had Orthostatic Hypotenstion. The test was

negative, but he noted "possible POTS seen at tailend of test". For those of you who have had a tilt test, what happened if and when you were given adrenaline?

Here are my results....

Laying

Max HR: 66 bpm

Max BP: 128/72

Standing (30 mins)

Max HR: 96 bpm

Max BP: 168/85

Symptoms: nausea, weakness, dizzy, feeling faint, having trouble staying awake/keeping my eyes open, my hand was turning purple

Because I didn't get the response they expected, they gave me Isoproterenol (adrenaline?)

Laying with adrenaline

Max HR: 77 bpm

Max BP: 138/60

Standing with adrenaline (11 mins)

Max HR: 120 bpm

Max BP: 170/71

Symptoms: chest pain, neck pain, shortness of breath, nausea, weakness, dizzy, feeling faint, having trouble staying awake/keeping my eyes open, purple hands

My HR went up to 113 almost immediately when they tilted me up after giving me the meds. They stopped the test once I hit 120 bpm and told them I was having chest and neck pain, 11 minutes after being tilted up.

[Libby]

Hi Purple! Welcome!

Usually, what they mean when they say the TTT was negative is that you didn't pass out/have pre-syncopal symptoms (mainly a large drop in BP/HR) to a degree that forced them to tilt you down.

Do you have the minute by minute breakdown of your HR/BP? POTS is currently defined by most as a 30+ BPM jump in HR (or a jump to over 120BPM) w/in the first 10 minutes of standing. According to the literature, you're just at the cut off - but I don't know when you hit 96, or if your resting HR was lower than 66, so I can't say for sure.

The iso is used to increase the chances of getting a faint. It's fairly specific in that it generally only induces syncope in people who would normally pass out, but who are having a 'good day' the day of the tilt. I don't think that the HR the adrenaline generates is used towards POTS diagnosis, though. I think your doc might've meant the tail-end of the original 30 minutes?...but that doesn't mesh with the 'first 10 minutes' clause, hm.

I can't answer the question about the effects of the iso, though - didn't make it that far. My body crapped out 15 minutes into the tilt.

[Purple]

Thanks for responding Libby!

My minimum resting HR was 64, so not a big difference. At first after they tilted me up my hr only went up to 77 (normal) right away, but within about 5 minutes it hit 96. For the next 25 minutes it dipped slightly, but stayed close to 96.

I'm also confused because on the report they said I was asymptomatic during that first 30 minutes. But I wasn't. I didn't faint, but I felt very sick. I was shaking and would have fallen if I wasn't strapped in. I felt nauseated, had a bad headache, neck pain, dizziness and I would start drifting to sleep but I was able to wake myself up. I was struggling to stay awake. But they didn't document any of those symptoms. I wasn't ok, but I was fighting through it. Is that normally what they do?

When you say your body "crapped out 15 minutes into the tilt", what happened? Did you pass out/faint? If not, what made them stop the test?

[flyingsquirrel]

Isoproterenol is not the same thing as adrenaline, although they are both catecholamines. (epinephrine = adrenaline)

Isoproterenol's main effect is increasing heart rate. This is the reason it is given in tilt table tests - to increase your heart rate (even more than standing does) to see if they can incduce symptoms. It also causes bronchodilation (similar to albuterol...it used to be used in asthma before there were better drugs). Unlike epinephrine/adrenaline, there is very little direct effect on vascular tone, therefore any effect on blood pressure is solely a result of increased heart rate.

[dakota]

I certainly don't know as much as many people on this forum, but I don't see why your doctor would say your TTT was "negative." Your heart rate did go up by 30 bpm. You also exhibited some typical symptoms like your hands turning purple, feeling nauseated and dizzy. You don't need to faint to be diagnosed with POTS. What actually strikes me was how high your blood pressure went. If he was testing for orthostatic hypotension, then yes, that test was negative. What did your doctor actually conclude? Just wondering.

[StephL]

This is why I drove 7 1/2 hours out of my way to go back to my doctor's hospital to do the TTT. I didn't trust the doctors around my area to do it completely.

I would make sure you get the actually results no the final report, if you don't already have them, and take see if you can submit them to someone else. Ask their opinion.

I don't trust any report I'm given, I want to see hard copies and then I go through the whole thing and research it all.

[Purple]

Isoproterenol is not the same thing as adrenaline, although they are both catecholamines. (epinephrine = adrenaline)

Isoproterenol's main effect is increasing heart rate. This is the reason it is given in tilt table tests - to increase your heart rate (even more than standing does) to see if they can incduce symptoms. It also causes bronchodilation (similar to albuterol...it used to be used in asthma before there were better drugs). Unlike epinephrine/adrenaline, there is very little direct effect on vascular tone, therefore any effect on blood pressure is solely a result of increased heart rate.

Thank you for the clarification Flying Squirrel! :-)

I certainly don't know as much as many people on this forum, but I don't see why your doctor would say your TTT was "negative." Your heart rate did go up by 30 bpm. You also exhibited some typical symptoms like your hands turning purple, feeling nauseated and dizzy. You don't need to faint to be diagnosed with POTS. What actually strikes me was how high your blood pressure went. If he was testing for orthostatic hypotension, then yes, that test was negative. What did your doctor actually conclude? Just wondering.

My doctor actually didn't tell me anything, even though I asked what the results meant specifically. After not getting answers, I sought a second opinion from a different cardiologist and that doc read through my initial doc's notes and saw that he wrote "possible POTS seen at tail end of test". I then requested the tilt table results and only got the report, but not the complete results. I called for them again today. Not sure what they will send this time.

Yes, he said that the test was negative because he was testing for Orthostatic Hypotension and that clearly wasn't what I have. After the test, without answering my questions, he prescribed Atenolol, only 12.5 mg at first to see if I can tolerate it, and put me on a Holter Monitor for 48 hours.

Dakota, the fact that my bp went that high worries me also. But I have no idea what that means. My bp is always very good when I'm sitting, roughly 120's/high60's to low 70's, but when I'm standing or doing chores and taking care of my babies sometimes it's insanely high. My cardiologist has said nothing about it. He wants me to increase my salt and fluid intake, but I'm worried about doing that since my bp does get so high. Last week at home I got a standing reading of 213/145 and HR 136 along with a ton of symptoms. Many other times I get error readings, I'm guessing because my BP and HR are so high.

[Purple]

This is why I drove 7 1/2 hours out of my way to go back to my doctor's hospital to do the TTT. I didn't trust the doctors around my area to do it completely.

I would make sure you get the actually results no the final report, if you don't already have them, and take see if you can submit them to someone else. Ask their opinion.

I don't trust any report I'm given, I want to see hard copies and then I go through the whole thing and research it all.

Thank you StephL! I completely agree. I need the actual results. So far everyone I've asked for the actual results says that there are no actual results other than the summary on the final report. I don't know if this makes sense, but I'm wondering if that may be because they were only focused on looking for my blood pressure to drop since my doc thought that I had Orthostatic Hypotension. Even on the final report it says I had no symptoms, even though I was constantly complaining of symptoms and even told her I couldn't do it anymore a few times. I'm wondering if it's possible that they just ignored everything other than my BP.

My doctor is the one who did the test but I don't think he knows much about POTS. He's an EP cardiologist.

[issie]

Sounds like HyperPOTS and I was told NOT to increase salt - because of the high bp's. But, others have been told to increase salt. Everyone has different docs and different "opinions" being given to them.

Issie

[StephL]

I'm fairly educated on this condition, not nearly as much as others here though. My point is that I'm no doctor so I don't know what that strip is called that comes out of the machine that shows your electric waves.

Whatever that is called, it should be a part of your results. I have mine. Well, I have papers with copies on them.

If you had the test done at a hospital, you should be able to go there and ask for it, forgo your doctor. Otherwise, I would try insisting that you get that with your doctor. I cannot imagine any reason why that strip wouldn't come out during the test, that is what they use to make their report.