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Tilt table test yesterday


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Hello,I made it to Mayo.I had several test yesterday,the tilt table was the first.My HR went up to 148 almost immedately.I stood for approx 7 mins before they laid me down.I am going for my sweat test in a few mins.They are very nice and extremely thourough here.They are also looking at the possibility that I have Sjorengs's.melanie

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Tilt table is like standing up... but they're monitoring the bp and hr in a real-time readout. Nina :rolleyes:

This is from the hospital where I had mine done:


What is a tilt table test?

Tilt table testing is designed to evaluate how your body regulates blood pressure in response to some very simple stresses. Blood pressure is regulated by a set of nerves which operate continuously and subconsciously and are part of the autonomic nervous system. This set of nerves detects certain bodily needs and they respond by causing the appropriate changes in blood pressure. The purpose of this part of the autonomic nervous system is to insure that there is always enough blood going to the brain, and to distribute blood to other organs according to their needs. For example, during exercise, blood is delivered preferentially to the muscles, whereas during eating blood is delivered preferentially to the intestines. These changes in blood pressure are accomplished by making changes in the way the heart beats and by making changes in the caliber or size of certain blood vessels.

At times, the nerves which control blood pressure may not operate properly and may cause a reaction which paradoxically causes the blood pressure to drop suddenly. This reaction may produce a fainting spell or a number of symptoms including severe lightheadedness. Tilt table testing is designed to determine the likelihood that a patient is susceptible to this type of reaction.

Who needs a tilt table test?

Patients that have symptoms suggestive of a sudden drop in blood pressure may benefit from the evaluation of blood pressure regulation with a tilt table test. The tilt table test was originally designed to evaluate patients with fainting spells because many fainting spells are caused by a drop in blood pressure. Tilt table testing may also be useful for patients who have symptoms of severe lightheadedness or dizziness which don't actually cause them to faint, but force them to sit down or lie down. These symptoms, while not progressing on to an actual fainting spell, may still be indicative of a sudden drop in blood pressure. Many patients suffering from the chronic fatigue syndrome have symptoms of lightheadedness and have been referred for tilt table testing.

What does tilt table testing involve?

The first part of a tilt table test evaluates how blood pressure responds to the simple stress of standing up, or in other words, how the blood pressure responds to the stress of gravity. Patients are asked to remove their clothing above the waist, put on a hospital gown, and lie down on a special table. Patients are connected to an electrocardiogram (ECG) type machine, have a small cuff placed around a finger which measures blood pressure, and have a small intravenous line (IV) placed into a vein in the arm. We try to make the setting as relaxing as possible by dimming the lights and by turning on some soft music in the background. After everything is set up we collect baseline blood pressure and ECG data for 10 minutes while you lie quietly on the table.

Do I have to have an intravenous line placed?

There are two reasons that we want every patient to have an intravenous line placed at the beginning of the study. First, it is conceivable (although rare), that a patient may have a reaction during the test that would require us to administer a medication intravenously. Even though the chance of such a reaction occurring is extremely rare, we prefer to have the intravenous line already in place as a safety measure. Second, many patients will require the infusion of isuprel to complete their tilt table test. We can only administer the isuprel through the intravenous line. While it may seem possible to place the intravenous line after the first part of the test, we have found that it becomes too disruptive to stop after the first part of the test, place the intravenous line, and then go on to complete the second part of the test. For these two reasons, we require that the intravenous line be placed at the beginning of the test.

We have had patients who have an extreme phobia to needles and/or to intravenous lines. If you have such a phobia, please let us know in advance and we will discuss the options with you prior to your test.

What protocol is used for the tilt table test?

After we have collected baseline data, the table will tilt you head-up to 30 degrees. Lying at a 30 degree angle feels like you are lying on a steep hill. You are tilted upright so that your head is always above your feel; we never tilt patients upside down. We will check your blood pressure and ECG for about 5 minutes in this position and then the table will tilt you head-up to 60 degrees. Even though you are lying on a table that is at a 60 degree angle, it feels as though you are standing on a footboard at the bottom of the table. You will be weight bearing. You will have two safety straps placed around your waist and your knees to make you feel secure.

We will be observing your blood pressure and ECG while you are head-up at 60 degrees for a long period of time, 45 minutes. There is no doubt that remaining still, essentially standing, for 45 minutes is boring and can be mildly uncomfortable. This prolonged period of time, however, is important because many of the patients that develop a sudden drop in their blood pressure do so after 30 minutes. While it would be natural to talk with you during this boring 45 minute period, talking actually disturbs our measurements of your ECG and your blood pressure so we ask you to be still and quiet. If you develop symptoms of any kind, however, we do want you to tell us. We try to make it as comfortable as possible for you. If you become extremely uncomfortable and cannot go on we will stop the test. If you complete the 45 minute period of head-up tilt at 60 degrees without developing a drop in your blood pressure, we will lower the table until you are flat and begin the second part of the test.

The second part of a tilt table test evaluates how blood pressure responds to a stress caused by a medication that is very much like your body's own adrenaline. Adrenaline is a hormone that is produced when you exercise or when you are angry or feel stress. The medication we use is called isuprel and produces the same effects as adrenaline. During this second part of the tilt table test, we infuse a very small dose of isuprel which is approximately equivalent to the amount of adrenaline your body would produce if you were to walk up a staircase. We begin the infusion slowly and increase it if necessary according to how your heart responds to the medication. You will feel your heart beating a little faster and stronger; some patients say if feels strange because they feel like they are exercising a little even though they are lying flat. After we find the appropriate dose of isuprel, the table will again tilt you head-up to 60 degrees. We will observe you at 60 degrees for 15 minutes. If you complete the 15 minutes of head-up tilt during the infusion of this small dose of isuprel, the table will be returned to the flat position. In some patients, we increase the dose of isuprel by a small amount and repeat the 60 degree head-up tilt for a third and final time.

Is this tilt table test protocol similar to the protocols that are being used at other hospitals?

We have been performing tilt table tests at Columbia Presbyterian Medical Center for the past 5 years. Our tilt table test protocol is nearly identical to the protocols used at The Johns Hopkins University Hospital, the Massachussets General Hospital, and a number of other hospitals in the country and around the world. Some hospitals use a 70 degree angle, although the difference between 60 and 70 degrees is inconsequential. We tend to use slightly lower doses of isuprel compared with other hospitals which we believe simplifies the interpretation of our tilt table test. The most important and universally agreed upon aspects of a tilt table test protocol is that the test include a prolonged period of head-up tilt in the drug-free state (before isuprel is used).

How long will the tilt table test take?

The duration of the tilt table test depends in part on how you respond. Some patients demonstrate the reaction that causes their blood pressure to fall suddenly in the first 20 minutes of head-up tilt to 60 degrees. Given the time it takes to set up the equipment and collect baseline data, the shortest possible test is 30-40 minutes. Other patients finish the entire protocol without demonstrating any such reaction (a negative test); these patients therefore finish all three stages of the test. If you finish the entire test, it will take approximately 2 hours.

Does everyone receive the infusion of isuprel?

Not everyone will receive the infusion of isuprel Some patients develop the reaction which causes a fall in blood pressure during the first part of the test. Once we observe this type of reaction, the test is terminated and there is no need to administer the isuprel. Unfortunately, we cannot predict ahead of time which patients will require isuprel and which patients will develop the reaction without isuprel.

If I have a very sensitive response to medications, how will you know how much isuprel to give me?

We always begin the isuprel infusion at an extremely low dose and increase it gradually. Having used isuprel for more than 30 years, we have a good understanding of the typical effect of isuprel on a wide variety of patients. Nevertheless, we still start the infusion at an extremely low dose. During the infusion, we continuously and carefully monitor your blood pressure and your ECG which provides us with information about how the isuprel is affecting you. Isuprel is a short lasting medication; when we stop the infusion, the effects of isuprel will wear off within a few minutes.

What is a positive test?

A tilt table test is called positive if a patient develops a drop in blood pressure associated with symptoms. The symptoms that patients experience are varied and have included lightheadedness, nausea, a cold and clammy feeling, sweating, a "spacey" feeling, or a feeling like you are about to black out. Rarely, blood pressure falls without the patient developing symptoms. In these cases, we try to continue the test until the patient develops symptoms. If the patient is able to complete the protocol without developing symptoms despite a fall in blood pressure, we call this a borderline test.

Some patients develop symptoms even though their blood pressure remains normal. While this would be considered a negative test, we do report the symptoms in the report and the corresponding blood pressure. In these cases the symptoms are not explained by changes in blood pressure or heart rate.

What does a positive test mean?

A positive tilt table test means that a patient is susceptible to one of the reactions that can cause a drop in blood pressure. Some of the reactions can be dangerous and require treatment, other reactions are benign and may not require treatment. Treatments vary from medication to a change in diet. The interpretation of the tilt table test is up to your physician. We provide your physician with the information necessary to interpret the test, but your physician knows you best and is the best person to interpret your test in the context of your other medical problems. Does everyone faint during a tilt table test?

Very few patients faint during a tilt table test. The vast majority of patients that have a positive test do not faint because we can see their blood pressure falling and we can return the table to the horizontal position before the patient faints. Typically, patients experience lightheadedness while their blood pressure is falling and while we are lowering them to the horizontal position. Rarely, a patient's blood pressure will fall so fast that we can not get them flat before they faint. These patients who do faint are usually only "out" for a few seconds and wake up as they are being lowered to the horizontal position. Patients have safety straps around them to prevent them from falling off the table if they do faint. There is always a doctor and a nurse in the room with the patient during the periods when the patient is tilted head-up to 60 degrees.

How will I feel after the test?

Many patients who have a positive test feel a little unsettled and sometimes queasy for the first few minutes after the test. We allow patients to fully recover prior to having them stand up and get dressed. The vast majority of patients will return to feeling completely normal within 5 to 10 minutes after the test. Rarely, a patient may continue to experience weakness or fatigue for a longer period of time after the test. Patients that have a negative test often report that the test was tiring but otherwise feel fine. If the patient received isuprel during the test, the effects of isuprel wear off within a few minutes of stopping the infusion.

Can I drive home after the test?

Many patients will drive home after the test. Since most patients return to feeling normal within 15 minutes after the test, there is no problem driving home after the test. The test itself, whether positive or negative, however, is quite tiring. For patients that live some distance from the hospital, we encourage them to bring someone else along with them who can drive them home in case the patient feels too tired to drive a long distance.

Why must I not eat before the test?

We ask that patients not eat for at least 4 hours prior to the test. For patients who have their tests scheduled in the morning, we ask that they not eat after midnight the night before the test. This is important for a few reasons. The way in which blood pressure is regulated is slightly different before and after a meal. In order to be able to properly interpret a test, we need to have the test done after the patient has not eaten for at least 4-8 hours. In addition, rare patients become quite nauseated during a reaction that causes blood pressure for fall. While it is extremely uncommon for a patient to actually vomit during such a reaction, it is important that the stomach be empty. For patients that have their test scheduled in the afternoon, we ask that they eat only a light breakfast and nothing for lunch. It is acceptable for a patient to have a few sips of water or juice in the morning to take a pill or just to moisten the palette.

If I have diabetes, should I take my medication on the morning of the test?

Patients that have diabetes mellitus and are using insulin or taking medication to control their blood sugar should talk to one of the Syncope Center physicians prior to their tilt table test. Usually, patients with diabetes will have to adjust their insulin or their medication on the day of their tilt table test in order to avoid their blood sugar from dropping too low.

Will my medications interfere with the test?

Very few medications actually interfere with a tilt table test. However, there are some medications which may affect the interpretation of the test. Patients should ask their physician or the physician ordering the tilt table test, whether or not they should continue to take their medications. Patients with questions about whether or not to take certain medications prior to the tilt table test should call the Syncope C

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