Tilt Up Table Test
The Tilt Up Table Test is typically used to evaluate people with unexplained lightheadedness or fainting spells. People with a positive test are typically given the diagnosis of "Neurally Mediated Syncope" or "Neurocardiogenic Syncope."

16 year old Jenny was advised by her doctor to get a Tilt Up Table test because she was having frequent fainting episodes.

How is the Tilt Table Test conducted?
The test takes about one hour. The patient lays on their back on a table and is then strapped to the table by three straps: one under the arms and across the upper abdomen, one across the pelvis, and the last one across the knees. The reason for the straps is to prevent the patient from falling and to prevent body movement during the test.

After recording measurements in the reclined position the table is then tilted (head up) to a maximum of 75 degrees. The heart rhythm and blood pressure are continuously monitored.

There is normally an increased heart rate to maintain normal blood pressure when the head is tilted up. Patients with neurocardiogenic syncope develop a sudden drop in heart rate and/or blood pressure after their body has been tilted up for several minutes. If symptoms of lightheadedness or fainting occur during this test, the test is considered positive for neurocardiogenic syncope.

What is being monitored?
While the patient is still in the flat position on the table, heart electrodes are placed across the chest to record the heart rate and heart wave (electrocardiogram). Also, the blood pressure is usually obtained by a cuff pressure or by placing an arterial line.

An intravenous line is also started so the patient can be given intravenous fluids to be sure that they are well hydrated. Special electrodes to measure the oxygen saturation in the brain are also placed on the forehead. Although this is not part of the standard procedure, this is an aspect that we expect will be used more and more.

Continuous minute-to-minute blood pressure, heart rate, and oxygen saturation are recorded.

Who performs the test?
The patient cardiologist and a registered nurse.

What happens during the test?
A very important aspect of the test is what is happening to the patient in relation to what is shown on the monitor. For example, if the patient is complaining of lightheadedness or dizziness, we look at the monitor and see that the blood pressure is dipping down, and we know that, dizziness is caused by the blood pressure dipping down. We ask the patient at the time when the symptoms occur, if these symptoms were experienced before in real life.

What is a positive test?
If the patient faints or is very close to faint

Any paradoxical relation between blood pressure and heart rate, e.g. the heart rate drops while the blood pressure is dropping.

The cardiologist may be anticipating a certain response to correlate with the patient pre-stated symptoms.

How long does it last?
The Tilt up Table Test lasts about 45 minutes standing at 75 degrees.

Is this a safe test?
This is a very safe test because we are trying to understand what is happening to the patient in real life in a very controlled environment. Your child may faint on the street and there would be no one around to help. Here in the hospital doctors are present and if your child is close to fainting the table will be eased back to a lying position, and consciousness is regained, and there is no risk of body injury.

We have conducted over 300 Tilt Table Tests and have not had a single complication.

Cardiac Electrophysiology Testing
This test makes precise measurements of the heart's electrical conduction system and determines the heart's vulnerability to developing either fast or slow rhythms which may cause syncope.

This testing often reveals the cause of syncope in patient's who have structural heart disease and/or have electrical abnormalities detected on the signal-averaged electrocardiogram or the Holter recording.

Electrophy-siology studies are remarkably well tolerated and require only local anesthesia for the placement of intravenous plastic coated wires called 'catheters'. During an electrophysiology study, the electrical impulses within the heart are recorded. The physician will try to stimulate the heart to beat abnormally, and determine whether the heart is susceptible to abnormal heart rhythms. If this happens, you may be started on a heart rhythm medication.