Tilt Testing

10th September 2023 | Dr Boon Lim

Introduction

If you are experiencing symptoms such as dizziness, loss of consciousness (fainting/blackouts),
unexplained falls and sometimes light headedness followed by palpitations or a racing heart you
may be asked to have a tilt test. This is also known as a tilt table test.

New symptoms may be due to a drop in blood pressure and or sometimes slowing of the heart rate,
usually when standing or seated) and a tilt test is awaiting which determine if this is happening to
you and why. It is a simple and safe test and often very useful in helping to reproduce symptoms
which may only occur very rarely.

What does it involve?

Tilt test are usually done in an outpatient hospital environment by a specialist cardiac nurse or
cardiac physiologist.
You are asked to lie down on the tilt bed. Three electrodes will be attached to your chest to monitor
your heart rate and rhythm. A blood pressure cuff will be attached to one of your arms and a finger
cuff will wrap around one of your fingers on the opposite am. In this way, a constant blood pressure
and monitoring of your heart can be obtained during the test. The lights will be dimmed a little and
the room is quiet. The tilt bed is then gently raised up to an almost vertical position and you will then
be asked to stand for a period of time. During this time the tilt nurse or technician will encourage
you to report any symptoms or changes that you experience as they happen. After a period of time,
if you have not felt any familiar symptoms, and are happy to continue, you may receive a spray
under the tongue a medicine called (GTN) which will challenge your blood pressure and heart rate a
little more. You are not then asked to remain on standing for a period of time to see how your body
responds and how it makes you feel.

How long does it take?

Tilt test protocols can vary. At Imperial for instance the maximum period of a tilt test would be 35
minutes standing. However each test is different because it depends on the experience of the
individual and what the tilt nurse or physiologist observes. A tilt test may last 3 minutes 33 minutes
or a whole test may be completed!
Remember- No two tests or patient experiences are likely ever to be the same because no one else
is you and because practitioner practices may differ.

How do you prepare?

You will be asked to avoid eating or drinking for a few hours prior to the test. This is to aid your
comfort and safety but also to ensure that the test is as accurate as it can be.

The effects of the tilt table test (including the use of GTN Glyceryl Trinitrate spray) are usually short
lived as people usually recover far quicker in this controlled environment than they may do in "real
life".