Stand Up Test Without Tilt Table

[michealdul]

My local doctor does not have special experiences with Dysautonomia but agreed about a stand up test (blood pressure + heart beat control) lasting for 12min. He normally does simple blood pressure tests but already heard about abnormal autonomic nervous system reactions. He informed himself and said a simple stand up test (standing freely supporting myself with my leg muscles vs. being bound to a table) would be useful.

So I was lying down ( 112:85 and HB 66). Then I stood up and standing incative for 12 minutes he checked pressure and heart beat for 15min every 3min ( 114: 86: HB 95, 118:85 HB 101, 117:81 HB 97, 112: 79 HB 98).

Is the simple stand up test a proper physical examination or should I repeat with a head-up tilt table test?

[corina]

I recently read an article on diagnosing via what we call "poor man's" tilt. I can't remember where or I should copy and paste the link for you here but if I remember well, this seems very reliable and no HUT would be needed. Having said that, you may need to check out other symptoms that could be connected with POTS. Hope this helps!

[SarahA33]

A tilt is considered the "gold standard", however, Clinical exam's are important, however, so is patient history as well. During a clinical exam my doctor has measured my vitals at 2, 5 and 10 min intervals (supine, sitting, standing) and has paid a lot of attention to my lower extremities to look at blood pooling. There's also close attention paid to my symptoms (lightheadedness, palpitations, flushing, migraine, nausea, etc.)

What symptoms did you have during your exam?

I'm glad that you have a doctor who is willing to help you!

If you do consider the tilt table, or you need a doctor who specializes in autonomic disorders, you can search our physician list for someone closest to you: http://dinet.org/index.php/physician-list Sarah

[michealdul]

Thank´s for your replies! During the test I became shaky, but I did not faint. I had strong cravings to move my legs but was told not to move. I felt better after sitting down later.

I am wondering if there is other diagnostic criteria for the so called poor mans´s test and the classic tild table test? Or do they both require a >30bpm or >120bpm heart rate during the test?

[Katybug]

Hi,

I agree with both of the other ladies. Also, fainting is not a requirement of diagnosis for the standing test or the tilt table test. (Many, including some docs who are not well versed in dysautonomia, have that misconception.)

The criteria for the standing and tilt table tests are the same. Based on the numbers you gave above, you seem to be within that criteria. The one thing that is difficult to address on the stand up test is that it is much easier to perform countermaneuvers, even very small ones, as opposed to the tilt table. When I do stand up tests, my heart rate often lingers in the 20-25 bpm increase but both of my tilt tests had my HR double in 3 minutes.

[srb]

I was diagnosed without the TTT. However, the rheumatologist I just saw did inquire as to why I had not had it done.

Here is the article that was posted on Facebook by DINET recently regarding this issue: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3478101/

I noted that the Dysautonmia Clinic posted a response in the comments when it was shared there.

[SarahA33]

Srb, Thanks for sharing this!

[toomanyproblems]

I was diagnosed without TTT. I was sent to a cardiologist for one but he said I didn't need to bother because of my clinical picture and extreme, consistent, well-documented HR changes upon standing. He did an ECG which was abnormal and an echo which was normal. Because POTS is common with CRPS, I sorta got the diagnosis through the back door as it were but it's a firm diagnosis. I just don't know which kind. I suspect that it's hyperandrogentic and that I also have EDS. They want me to go somewhere like Cleveland Clinic for a huge work up but I'm not much feeling like it would be worth it. The neuro I went to today wants to try the simple things first and I'm on board with that if we can get my other specialists to agree.

[srb]

My pleasure, SarahA33 :-)