What is a hemodynamic tilt test?
A hemodynamic tilt test is used to check your blood circulation and to see how well your heart is working. It is done using nuclear imaging. You may also hear the test referred to as a technetium (pronounced tek-nee-see-um) hemodynamic test.
Why do I need this test?
Your doctor will use the information collected during the test to find the cause of your syncope or circulation disorder. The test results will also help determine your best plan of care.
What is syncope?
Syncope (pronounced “sin ko pea”) is commonly called fainting or passing out. It happens when there is a temporary decrease in the blood flow to your brain. Syncope can happen if you have a sudden drop in blood pressure, heart rate or changes in blood volume or distribution. An episode usually ends quickly, but you may feel confused afterwards.
Many people who have syncope have a medical condition related to the heart, nervous system or blood flow to the brain.
What are the risks of the test?
All procedures have risks. Your healthcare provider will talk to you about the risks and benefits of the hemodynamic tilt test before you agree to have it done.
You may have some bruising or swelling in the area where you get your IV. This is common. You may also have pain or discomfort when the IV is inserted. Please talk to the lab staff if you are concerned about getting an IV.
How long does the test last?
The test takes about 2.25 hours. Plan on being at the hospital for 2.5 to 3 hours for your appointment.
Before the Test
Can I eat before the test?
DO NOT eat or drink anything for 4 hours before the test. This includes gum and candy. If you need to take medications, take them with a small sip of water.
DO NOT eat or drink anything that contains caffeine on the day of your test. This includes anything labeled “caffeine-free” or “decaffeinated” — these products may contain small amounts of caffeine.
Should I take my medications?
Do not take strong diuretics (“water pills”) or laxatives before the test. It is best if you do not need to get up during the test. You can take all other medications as you normally do. Ask your doctor or pharmacist if any of your medications contain caffeine and if you should take these on the day of the test. Do not stop taking any medication without first asking your doctor.
What should I wear?
Wear comfortable clothes and shoes. You will undress from the waist up and wear a hospital gown during the test. DO NOT wear jewelry (including wedding rings).
What should I bring?
- Your recent medical history and physical exam report.
- Any available medical records related to your health problems.
- List of all medications and supplements you take (including how much you take).
- List of all your allergies.
- Your insurance card.
- DO NOT bring valuables.
What happens before the test?
A nurse or technologist will explain the procedure in detail and answer any questions you have.
You cannot have the test if you are pregnant or breast feeding. We may ask you to take a pregnancy test for your safety.
You will get an IV. The IV is used to give you the radioactive isotope and tagging agent. The IV is also used to give you other medications you may need during the test.
During the Test
EKG Monitoring: Small, sticky patches called electrodes are placed on your chest. The electrodes are connected to an electrocardiograph (EKG/ECG) monitor that records the electrical activity of your heart as a graph on a moving strip of paper. The EKG shows your heart rate and rhythm during the test.
Blood Pressure Monitoring: A blood pressure cuff on your arm is used to check your blood pressure at different times during the test.
Hemodynamic Echo: You will have an echo before you start your test, after you have rested for 20 minutes. The test takes about 20 minutes and is used to get detailed pictures of your heart. It also measures the amount of blood your heart pumps out (cardiac output). Your cardiac output will be measured again during the test and compared to the first.
Imaging: A special camera called a gamma camera is used to take pictures during the test. The camera is placed over your chest. You will need to stay still during this part of the test.
The camera works with a radioactive isotope (tracer) called 99-m-Technetium. The tracer is injected into your IV before you have each set of images. A computer connected to the camera detects the radiation from the tracer and creates a series of images. You will have up to three sets of images—two while you are lying flat and one while you are sitting. The images give your doctor information about how well your heart is working and your blood circulation, such as how much blood is being pumped and how fast it is moving.
The radioactive isotope is not a dye and does not cause any allergic side effects. The amount of radiation used in the test is very low — about the same as you are exposed to during a chest X-ray.
Will I be awake during the test?
Yes. You will be awake during the test. We will do everything we can to make you comfortable. Please try to stay as still and as quiet as you can so we can get the best recordings possible.
How will I feel during the test?
We will ask you how you feel during the test. You may not have any symptoms, but it is not unusual to feel light-headed, nauseous or have heart palpitations,
You may feel pressure and a rush up your arm when the radioactive agent goes through your IV. You may also notice a metallic taste in your mouth or a strange smell in your nose. These do not last long.
It is important to tell us how you feel during the test. We can make changes between sets of images to help you feel more comfortable. Your symptoms, along with your test information will help your doctor determine the cause of your condition.
After the Test
What happens after the test?
- You will stay in the lab area until any symptoms you had are gone.
- Your IV will stay in until you finish your last test of the day.
- Some of the tracer used in the test will leave your body through your urine. The rest breaks down naturally. If you want, you can drink extra fluids to help flush out the tracer.
- The isotope used during the test may cause the alarm to sound when going through airport security. You will get a Homeland Security card to carry with you when traveling for 1 week after the test.
Going home after the test
Most patients go home right after the test. You may want to have a driver with you in case you have severe symptoms.
Your doctor will use the test results to create your plan of care. You may need to take new or different medications. You may also be referred to other doctors to help manage your care.
Action Checklist
THE DAY OF YOUR TEST
- DO NOT eat or drink anything for 4 hours before the test.
- DO NOT eat or drink anything that contains caffeine (including decaf/caffeine-free items).
- Take your regular medications with small sips of water. DO NOT take diuretics or laxatives.
- If you have diabetes, request a 12:30 p.m. appointment so you can eat a light breakfast before 8:30 a.m.
- Wear comfortable clothes and shoes.
- DO NOT wear jewelry (including your wedding ring).
- DO NOT bring valuables.
- Bring a list of all medications and supplements you take and any available medical reports (if your referring doctor is not a Cleveland Clinic doctor).
- Tell us about all allergies you have.
DURING YOUR TEST
- You will have an IV.
- Lie quietly and do not move.
- Tell us about any symptoms you have.
- If you have any questions, please ask.
AFTER YOUR TEST
- Have someone available to drive you home in case you have severe symptoms.
- Your referring doctor will get your test results in about 10-14 days and talk to you about your plan of care.
- Follow your plan of care and see your doctor for all follow-up visits.
- Tell your doctor about any new symptoms or side effects you have.
