Tilt Test

What is a Tilt Test?
A Tilt Test is the only effective non-invasive technique for investigating a patient with neurally mediated syncope (vasovagal syncope, carotid sinus syndrome, micturition syncope) occurring in the absence of structural heart disease. The test involves being tilted, always with the head-up, at different angles for a period of time (2 minutes at 30 degrees, then 2 minutes at 45 degrees, then up to 45 minutes at 70 degrees). During the test, your heart rhythm, blood pressure and other symptoms are closely monitored and evaluated with changes in position.

What information is provided by the Tilt test?

The tilt test helps to confirm the diagnosis of neurally mediated syncope. This is extremely important because there is effective treatment for this condition which can either totally eradicate or dramatically reduce the frequency and intensity of symptoms (dizziness and black out spells).

How is the Tilt Test Performed?

During the test you will lie on a special bed that has a foot-board and a motor so that it can tilt to different degrees, as described above.

  • The technician will place a cannula in your arm in case you need to be given any medications during the procedure, to treat your symptoms and/or blood pressure and heart rate changes.
  • You will be connected to several monitors (for monitoring your electrocardiogram (ECG) and blood pressure, and sometimes respiration and blood-oxygen).
  • You will be awake but will be asked to lie quietly and keep your legs still.
  • The test involves being tilted at different angles for a period of time. Blood pressure, heart rate and other measurements are recorded during the test. You may feel no symptoms at all; you may feel symptoms of lightheadedness, nausea, dizziness, palpitation (fluttering in the chest) or blurred vision; or you may faint. It is important to tell your doctor or nurse any symptoms you feel.
  • The full test lasts about one hour and 15 minutes.
  • If nothing happens the tilt test may need to be repeated with a drug to try to provoke the symptoms. In this case, your doctor may give you a medication called isoprenaline as an infusion. This medication may make you feel nervous, jittery, or that your heart is beating faster or stronger. This feeling will go away as the medication wears off. Your blood pressure, heart rate and symptoms will be closely monitored and evaluated.

How do I prepare for the Tilt test?

  • Check with your doctor to see if any of your medications need to be stopped before the test.
  • You should not eat or drink after midnight to reduce the risk of nausea and vomiting during the test.
  • Please make sure that somebody can drive you home after the test.
  • Is there any risk?
  • Serious complications are very rare, but because of the nature of the test, it can be quite dramatic for the patient if the test is positive and causes a black out spell. In rare cases, the test may produce a persistent abnormal heart rhythm. Experienced staff and equipment are on hand to handle these potential complications.

How quickly will I get the results of the Tilt Test?

The tilt test results are generally provided to you as soon as it is completed. Changes in your medications, if indicated by the results of the test, may be discussed at the same time or at a subsequent visit to your Cardiologist.

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