Upright tilt table testing in the evaluation of syncope
- David Benditt, MD
David Benditt, MD
- Professor of Medicine
- Director, Cardiac Arrhythmia Center
- University of Minnesota Medical School
The upright tilt table test is sometimes performed in the evaluation of a patient with suspected syncope. Tilt table testing may be helpful in patients in whom the diagnosis of vasovagal syncope is suspected but not certain [1,2]. It is also useful in older persons in whom the cause of syncope remains unclear, but vasovagal syncope is suspected [2,3].
The indications for tilt table testing, along with a description of the procedures and discussion of the results, will be reviewed here. The general evaluation of the patient with transient loss of consciousness (TLOC) and suspected syncope, as well as a detailed discussion of reflex syncope, are discussed separately. (See "Syncope in adults: Clinical manifestations and diagnostic evaluation" and "Reflex syncope in adults: Clinical presentation and diagnostic evaluation".)
DEFINITION AND CAUSES OF SYNCOPE
Syncope is a clinical syndrome in which transient loss of consciousness (TLOC) is caused by a period of inadequate cerebral nutrient flow, most often the result of an abrupt drop of systemic blood pressure. Typically, the inadequate cerebral nutrient flow is of relatively brief duration (8 to 10 seconds) and, in syncope, is by definition spontaneously self-limited.
Loss of postural tone is inevitable with loss of consciousness, and consequently syncope usually is associated with collapse, which may trigger injury due to a fall (such as may occur if the person is standing) or other type of accident (eg, if syncope occurs while driving). Recovery from true syncope is usually complete and rapid, with episodes rarely lasting more than a minute or two. Longer periods of real or apparent loss of consciousness suggest that the event is not syncope.
Syncope is but one form of TLOC. The possible causes of TLOC resulting in true syncope are generally grouped into four major categories:
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- DEFINITION AND CAUSES OF SYNCOPE
- TILT TABLE TESTING PROCEDURE
- Patient preparation and necessary equipment
- Tilt protocol
- - Starting the test
- - Passive phase
- - Drug provocation phase
- Comparison of isoproterenol and nitroglycerin
- TILT TABLE TEST RESULTS
- Test interpretation
- Test performance
- SUMMARY AND RECOMMENDATIONS