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Newbie question: how to get a tilt table test/what are they for?


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Hello, I'm new here and stumbled on this forum. 
I've had issues with getting dizzy every time I stand up since I've been a teenager and it's been getting a lot worse lately (I'm 30 now) where I end up on the floor for a few minutes until I feel okay enough to stand. It's much worse in the summer/when I'm hot. I've had a Primary Care Physician a few years ago tell me that it's orthostatic hypotension and that I should make sure to drink enough water/add salt/maybe wear compression salt, but she told me that based off my symptoms and I think she gave me that diagnosis because my resting BP is relatively low. (usually about 100/60). She didn't test my BP when sitting/standing or anything like that. A friend of mine who is a doctor in another state recently asked me if I've ever done a tilt table test and I said no, what's that? and she said she's surprised I haven't. 
So I guess my questions are (1) should I? and (2) if yes, how does one go about getting one? I don't have a regular primary care physician right now. my last one sadly left my city and I haven't found a new once since. 

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Hello @Cara - if orthostatic Vital signs confirm diagnosis of orthostatic hypotension or neuro-cardiogenic syncope ( same symptoms but actual syncope when the BP drops ) many physicians do not see the need for a TTT. However - if there is any  question about a diagnosis or they want to determine of it is another dysautonomia, like POTS, physicians may order a TTT. Usually a cardiologist or electro-physiologist perform them. Depending on your insurance you may or may not need a referral from a PCP.  And I agree with you PCP from a few years ago: increase in fluid and salt intake as well as compression hose and exercise are recommended for most dysautonomia cases - especially for symptoms such a yours. 

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Is there anything else that can be done besides those things (fluid, salt, compression stockings)? The dizziness has been getting worse and more frequent lately and I'm not sure what to do. Thanks so much for the quick response. 

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8 hours ago, Cara said:

Is there anything else that can be done besides those things (fluid, salt, compression stockings)? The dizziness has been getting worse and more frequent lately and I'm not sure what to do. Thanks so much for the quick response. 

Does your HR increase when you stand or is it just your BP dropping? For low BP commonly doctors prescribe Fludrocortisone or Midodrin. These agents work to bring low BP up. If your HR is affected they often order a beta blocker.  For many people the salt/fluid/compression alone is enough IF DONE EFFECTIVELY. If you suffer from low BP despite these measures I would ask your doctor about trying medication. 

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@PistolI don't know what is happening when I stand up because I haven't been tested. My former PCP just told me it was likely blood pressure dropping, but she never tested to see what was actually happening. I do often feel like my heart is racing but I don't know what the actual HR is because I can't measure it.

Can a PCP test this with a blood pressure cuff or would i have to do the tilt table test? Thank you so much. 

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You can do what's known as a poor man's tilt table test yourself with a cheap BP monitor or get your PCP to do it  - lie down for 5 minutes and measure HR and BP.  Then stand up and measure HR and BP after 5 and 10 minutes.  For a POTS diagnosis you need a rise of at least 30 bpm in your HR which is sustained or for your HR to be higher than 120 bpm and for orthostatic intolerance I think it's a drop of 20 points although I'm sure @Pistol can confirm that.  

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19 hours ago, Cara said:

Hello, I'm new here and stumbled on this forum. 
I've had issues with getting dizzy every time I stand up since I've been a teenager and it's been getting a lot worse lately (I'm 30 now) where I end up on the floor for a few minutes until I feel okay enough to stand. It's much worse in the summer/when I'm hot. I've had a Primary Care Physician a few years ago tell me that it's orthostatic hypotension and that I should make sure to drink enough water/add salt/maybe wear compression salt, but she told me that based off my symptoms and I think she gave me that diagnosis because my resting BP is relatively low. (usually about 100/60). She didn't test my BP when sitting/standing or anything like that. A friend of mine who is a doctor in another state recently asked me if I've ever done a tilt table test and I said no, what's that? and she said she's surprised I haven't. 
So I guess my questions are (1) should I? and (2) if yes, how does one go about getting one? I don't have a regular primary care physician right now. my last one sadly left my city and I haven't found a new once since. 

Hi,   There is info about dysautonomia doctors on the Dinet website,  I would try to find one close to you, get a referral from your primary and they can run the test,.  You can also do a poor man’s tilt test at home, measuring your own HR and BP.  If you google or search the forum you will find instructions. There are a million different medications and treatments you can try which a good POTS doctor can help you figure out.  There is also info on those treatments on the Dinet page.  I hope you feel better soon! 

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@Cara - look at our physicians list here https://www.dinet.org/physicians/ and see if you can find someone close to you. also - it is very important to have a PCP that will help you with your health care, he or she can do orthostatic Vital signs ( or poor mans tilt ) in the office with a regular BP cuff nd by counting your HR. This is better than doing it yourself b/c the results will go in your medical record. 

 

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A poor man’s tilt table test can be really helpful in identifying the basics: whether you have just orthostatic hypertension or whether you also have POTS. It is easy to do at home and would be one step toward identifying your next step!

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