Is A Ttt Really The "gold' Standard Of Testing

[Rebadawn]

After 14 years of suffering from various symptoms, and being told none of them "fit" so must be stress or depression, the specialist who performed my sleep study finally gave me the diagnosis after reviewing my medical records.

I was scheduled a TTT to confirm. During the test, my blood pressure stayed stable, however, my heart rate went from 79 to 105 upon standing and did not go back down. I was given nitro spray and BP stayed normal, heart rate went to 125. I did not pass out, but fell asleep. My Cardiologist reported the test as being normal, thus ruling out POTS.

I have been experiencing syncope since March (have never passed out in my life before that) and continue to do so.

My question is, just how reliable is the TTT?

[tampafd]

I had the tilt table test about 3 weeks ago. I have orthostatic hypotension. After not having much of a blood pressure dropped the first 23 minutes my blood pressure crashed at 24 minutes dropping to 60/30 causing me to pass out. I am 57 and I have never fainted in my life. So i say the test is pretty reliable.

[rubytuesday]

The TTT is one of the first of many tests that I had. I had never completely lost consciousness before then just 'near syncope', very near syncope that would drop me to the ground. Apparently I fit the symptoms but never passed out. I was not given any ntg. I had a 24 hr event monitor (had requested 30 day event monitor as I was not feeling symptoms on a daily basis when things first began). I had never passed out before in my life either. The 24 hour event monitor was normal, but as symptoms persisted, I was put on the 30 day event monitor and within 2 weeks, I received a call from the cardiologist that I was having some sort of tachycardic episodes. From there it began, one medication to another with dosage adjustments, etc. all to no avail. The following spring (almost a year later), my cardiologist wanted another TTT but this time to be done by a different cardiologist/physiatrist. Again I did not pass out but was told that my BP and tachy fit the mold for neurocardiogenic syncope. Again more trials of medications that did not work in addition to examination by neurology and endocrinology. The condition progressed to POTS. My cardiologist referred me to a specialist in dysautonomia and he confirmed POTS and orthostatic hypotension, telling me that 'down the road' I was going to need a pacemaker. In a little over a year from my first visit to him, I did need to have the pacer placed. It senses when the blood doesn't return fast enough to my heart and kicks the heart in to beat faster/harder. I was shocked at my first pacemaker check to learn that the pacemaker was doing over 60% of the work of my upper heart.

Yes, I would say there are things that can be found and/or ruled out. My cardiac physiatrist told me that he believed that the reason I did not lose consciousness was that their TTT room is cold, despite the efforts they make to create a warm environment for the study, it does not get warm enough for some. You might consider a repeat TTT and perhaps at another facility or by a different cardiac physiatrist. The environment for the study can be a big factor on the outcome.

I was very blessed in being a menopausal female that things were not dismissed as anxiety or stress since little can be in black and white unless you get seen as the event/symptoms are occurring. It took them nearly 2 1/2 years to establish the right diagnosis and treatments for me. I was not, however, responding to the treatments and was referred to a cardiac specialist in dysautonomia. I doubt he would have ever considered seeing me had I not had the TTT (along with the medical records from the cardiologist of my history).

I also started keeping a record MedHelp(.org or .com) had an excellent way that one can enter the blood pressures and heart rates. Whenever I had a 'spell' I would check my vital signs and enter them in on its tracker. You can print out a graph of your results to take to your next appointment to have something in black and white that shows what is happening to you. Along with the graph, I would keep another record of the dates/times of my 'spells', symptoms and what I was doing at the time it occurred. I think it really helped to get to the root of things. I would highlight my extreme lows with the BP and highs with the HR. The graph also documents your high and low HR/BP for 30, 60, 90 days. At least it offers data that is objective.

Best wishes on your venture to better health

ruby

[statesof]

The tilt table test is one of the few tests that can show doctors that there is a problem by statistical data, as well as with the valsalva and sweat part of the test they typically run with the tilt table test. That is why it is seen as the current "standard". However your numbers on the ttt are not necessarily an indication of how bad your symptoms are, though sometimes it can be. The trouble is that doctors do not know exactly what POTS is, as far as what specific problem in the body is causing it, and how everything in your body is affected by it. And there are not many other tests that can accurately show there is a problem, that is why many of us have perfect blood tests, mris, etc. a full patient history taken by an autonomic specialist is just as important to a ttt, in getting a diagnosis. Many times they can be some of the only doctors who understand this condition well enough to make a accurate diagnosis, as well we all have a slightly different set of symptoms while sharing the same condition.