Tilt Table Test

A tilt table test, also called head-up tilt table (HUTT) testing, is a procedure that healthcare providers use to understand why you have fainting episodes.

In this test, you’re securely fastened to a padded table that providers quickly move from a flat to a vertical position. This mimics the act of standing up. Devices monitor your blood pressure, heart rate and heart rhythm to see how your body reacts. This is among the most detailed ways to study the cause of fainting.

Your provider may suggest this test if you’ve fainted multiple times without a clear reason. Before doing a tilt table test, providers rule out any heart-related causes, like arrhythmias or problems with your heart’s structure. HUTT may help diagnose or manage:

• Orthostatic hypotension: This means your blood pressure drops more than it should when you stand up. The quick drop may cause dizziness or fainting.
• Postural orthostatic tachycardia syndrome (POTS): This condition makes your heart beat faster than it should when you stand up. This can lead to fainting and other symptoms.
• Vasovagal syncope: This means you faint when your nervous system overreacts to something like medical instruments, stress or fatigue.

Rarely, people faint during tilt table testing. But providers are right there with you. So, they can put the table back down so you can recover quickly. You may also feel tired and/or have an upset stomach. Some people release pee when they faint.

Tilt table testing may not be safe for you if you’re pregnant or have blockages in arteries that supply blood to your heart or brain. Your provider will review your medical history before doing this test to make sure it’s right for you.

How does the test work?

Tilt table testing moves your body from a flat to an upright position. This forces the network of nerves that control automatic processes (autonomic nervous system) to maintain your blood pressure. Normally, it can do that just fine.

But certain medical conditions, like vasovagal syncope and POTS, disrupt those normal processes. That’s why you might faint — or come close to fainting — when you stand up after lying down.

This test lets your healthcare provider see how your blood pressure and heart rate change when you shift body positions. You’re connected to monitors that track your vital signs the whole time. This gives valuable data to your provider. The test can help diagnose or rule out conditions that cause fainting. This lets you get the treatment you need.

What happens during a tilt table test?

The healthcare provider who ordered the test will tell you how to prepare. They may ask you to avoid caffeine and alcohol for 12 hours prior to the test. You may also need to fast (no food or drinks except water) for at least two hours before the test. It’s generally considered unsafe to drive yourself home after tilt table testing. So, be sure to arrange for someone to drive you to and from your appointment.

Tilt table testing happens in a safe, controlled environment. Your healthcare provider will:

• Help you onto the table: It’s padded and has straps that help keep your chest and legs in place. A footrest keeps your feet flat. You don’t use your leg muscles to actively stand or stay upright.
• Connect you to monitors: You’ll have a blood pressure cuff on your arm and another one on your finger. Your provider will also connect you to an EKG monitor to record your heart’s electrical activity (rate and rhythm).
• Start the resting phase: This lasts at least 10 minutes. You’ll lie flat on the table without moving. The monitors collect data on your blood pressure and heart activity.
• Tilt the table: Your provider will tilt the table upward so you’re almost standing upright. This is usually around a 70-degree angle. You’ll go from flat to upright within about 10 seconds.
• Watch and wait: You’ll stay in this upright position for up to 45 minutes. Your provider will closely monitor your vital signs and record data. They’ll also ask you to speak up about any symptoms, like dizziness or nausea.

Your provider will stop the test if you develop symptoms. You may faint. But try not to be scared or nervous about this happening. If you faint, providers will move the table back down right away so you can recover quickly.

In the past, tilt table testing sometimes involved two parts. The first part was tilting the table. Then, if symptoms didn’t appear, providers would give you medication to make your heart beat faster. This could sometimes trigger symptoms and help get more helpful information. Providers less commonly use medications these days but may still consider doing so in select cases.

What happens after the test

After the test, your provider will lower the table to a flat position. You’ll stay on the table for five to 10 minutes as you lie flat. This lets them make sure you’re OK. They’ll measure your blood pressure, heart rate and heart rhythm.

It’s rare for severe symptoms to continue after the test. But if this happens, you may need care in the emergency department. Most people can go home after the test is done.

You can eat normally after the test unless you have other tests scheduled that require you to fast.

What do test results look like?

There are two types of results you can get from tilt table testing:

• Positive: Your body responded abnormally. This means you had symptoms like dizziness or fainting. Plus, monitors may show tell-tale signs like a large drop in blood pressure (for vasovagal syncope or orthostatic hypotension) or a large increase in heart rate (for POTS).
• Negative: Your body responded normally. This means you didn’t have symptoms or faint. Monitors may show a mild drop in blood pressure and a mild increase in heart rate.

If you get a positive result, your healthcare provider will explain what this might mean for you. They’ll look at the data from the monitors along with your symptoms and medical history to reach a diagnosis.

Your provider may want to run the test again if they think the results aren’t right.

Follow-up

You may need more tests to figure out what’s causing you to faint. Your healthcare provider will explain next steps. Ask if anything’s unclear.

It’s also important to ask your provider about medications. Based on your tilt table test results, you may need to make changes to the types or amounts of medications you take. Follow the treatment plan your provider prescribes.

When should I call my doctor?

Call your provider with any questions about tilt table testing or how to prepare. They’ll help you feel comfortable about the process.

And be sure to tell your provider if you have new or changing symptoms at any point.