Fainting Spells? A Tilt Table Test Can Help Us See Why

You’re just going about your day, maybe standing in a queue or chatting with a friend, and then it hits you. The world starts to feel a bit… off. Maybe you get lightheaded, a little queasy, your vision might tunnel. And then, sometimes, everything goes dark for a moment. Waking up feeling confused and maybe a bit embarrassed is no fun at all. If these fainting spells, or what we doctors call syncope, sound familiar, we need to get to the bottom of it. One of the ways we can investigate these episodes is with a procedure called a Tilt Table Test.

It sounds a bit like something out of a sci-fi movie, doesn’t it? But it’s actually a really useful way for us to see how your body, specifically your heart rate and blood pressure, reacts to changes in position.

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So, What Exactly is a Tilt Table Test?

Think of it like this: when you stand up, your body has to quickly adjust to keep blood flowing to your brain. Usually, this happens automatically. But sometimes, that system can get a bit out of sync, leading to those dizzy spells or even passing out. A Tilt Table Test helps us understand if this is what’s happening to you.

Essentially, you’ll lie on a special table that can be gently tilted upwards, mimicking the change from lying down to standing up. We do this in a very controlled and safe way, of course. Throughout the test, we’ll be keeping a close eye on:

Your blood pressure
Your heart rate
Your heart rhythm (using an EKG, or electrocardiograph)

This information helps us see if changes in your position are causing those symptoms like lightheadedness or fainting. It’s all about figuring out the “why” so we can find the best way to help you feel better. These tests are usually done in a hospital or a specialized clinic, often in what’s called an electrophysiology lab or a tilt lab.

The whole thing might take around 90 minutes if we go through all the stages. But, if your symptoms pop up earlier, it could be shorter, maybe 30 to 40 minutes. Once we see what we need to, that’s often enough.

Getting Ready for Your Test

Like any medical test, a little preparation helps things go smoothly. I always tell my patients, don’t worry, we’ll go over everything.

Eating and Drinking:

You can eat a normal dinner the night before.
On the day of the test, though, we usually ask you not to eat or drink anything for about four hours beforehand. Small sips of water are generally okay.
Definitely skip the coffee or any caffeinated drinks that day.

Medications:

Most of the time, you can take your regular prescription medications with a little water.
If you’re on a diuretic (a “water pill”), chat with your doctor. We might ask you to hold off on taking it until after the test.
Best to avoid any laxatives before the test.
If you have diabetes and take insulin or other medications, please talk to your doctor about how to manage them on test day. It’s a good idea to bring your glucose meter, just in case.
And, of course, never stop any medication without talking to us first!

What to Wear and Bring:

Comfort is key! Wear loose, comfortable clothes and shoes. A short-sleeved or sleeveless t-shirt can often be worn instead of a hospital gown.
You might want to bring a change of clothes. It’s rare, but sometimes people can feel a bit sick or, if they faint, might lose bladder control. Better to be prepared.
It’s helpful to bring:
A list of your current medications and their dosages.
Any medical reports you have that might be relevant.
A list of any allergies (medications, food, anything!).
Your insurance information.
Probably best to leave valuables at home.
And please, arrange for someone to drive you home. You won’t be able to drive yourself afterwards.

What Happens During the Tilt Table Test?

I know the idea of a test can be a bit nerve-wracking, but there will be medical staff with you every step of the way, making sure you’re as comfortable as possible.

Getting Set Up:

First, we’ll explain everything again, answer any last-minute questions, and you’ll sign a consent form if you haven’t already.

Then, we’ll help you lie down on the motorized table. There’s a footboard for your feet to rest against.

We’ll secure soft straps across your body – these are just for safety, to make sure you’re secure if you do feel faint. You’ll still need to support your own weight when tilted.

An IV (a small tube) will be placed in a vein in your arm or hand. This is so we can give medication if needed during the test, or take blood samples.

We’ll put blood pressure cuffs on one arm and a finger. These will keep track of your blood pressure. The one on your finger will be working constantly, and the arm cuff will check every few minutes.

Small, sticky patches called electrodes will be placed on your chest. These connect to an EKG machine, which lets us watch your heart’s electrical activity.

The Test Itself – Part One:

You’ll start by just resting flat for about 15 minutes. We’ll get some baseline readings of your blood pressure and EKG.

Then, the table will be slowly tilted upwards. It’s always head-up.

First to about 30 degrees for a couple of minutes.
Then to 45 degrees for another couple of minutes.
Finally, to around 70 degrees. You might stay in this position for up to 45 minutes.

The most important thing during this part? Try to stay as still and quiet as you can. Don’t move your legs. And please, tell us immediately if you start feeling anything – lightheaded, dizzy, sick to your stomach, heart flutters (palpitations), blurred vision, a headache. Anything at all.

The Test Itself – Part Two (If Needed):

If your blood pressure stays stable during the first part, we might move on to part two. This involves giving you a medication – either through your IV, as a pill, or a spray in your mouth. This medicine makes your heart beat a bit faster and stronger. It helps us see how your body responds under a little more challenge.

After you get the medicine, the table will be tilted again, usually to about 60 degrees, for up to 15 minutes.

If your blood pressure drops during this time, or if you develop symptoms, that often gives us the answers we need, and the test will end. Either way, this part is usually done within 15 minutes.

How Will You Feel?

It really varies. Some people don’t feel much at all. Others might experience those pre-fainting symptoms we talked about:

Feeling lightheaded or dizzy
Nausea (feeling sick to your stomach)
Palpitations (that fluttery or racing feeling in your chest)
Blurred vision or a headache

The goal isn’t to make you faint. But, it can happen, and that’s okay – it actually gives us very important information. The team is right there to lower the table and help you recover quickly.

We’ll be asking you how you’re feeling throughout. Sometimes we use a scale from 1 to 10. Your feedback is a crucial part of the test. If you feel you can’t continue, let us know. But if it’s safe, we’ll encourage you to hang in there so we get the most complete picture.

After the Test

Once the test is over, we’ll lower the table so you’re lying flat again. You’ll rest there for 5 to 10 minutes while we continue to monitor you, just to make sure everything’s settling back to normal.

If you had an IV, we’ll usually take it out then, unless you have other tests scheduled.

Most people feel fine to go home after a short rest. Remember, you must have someone to drive you. You shouldn’t drive for the rest of the day.

You can usually eat and drink normally afterwards, unless other tests require you to keep fasting.

If you notice any new or ongoing symptoms after you leave, please let your doctor know.

Are There Any Risks?

Tilt table tests are generally very safe. The most common thing is feeling faint or actually fainting, but as I said, we’re right there to manage it. You might feel tired or have a bit of an upset stomach afterwards. Some people, if they faint, might lose bladder control for a moment – it happens, and it’s nothing to be embarrassed about.

Very, very rarely, in people who have significantly narrowed arteries (like coronary arteries in the heart or carotid arteries in the neck), there could be a risk of more serious issues like a heart attack or stroke. We always discuss any specific risks with you beforehand and can modify the test if needed.

Understanding Your Tilt Table Test Results

So, what do the results mean?

A positive tilt table test usually means that we saw changes in your blood pressure, heart rate, or heart rhythm that could explain your fainting or pre-fainting symptoms. This could point to conditions like:

Bradycardia (an unusually slow heartbeat)
Tachycardia (an unusually fast heartbeat)
Hypoglycemia (low blood sugar, though less commonly diagnosed solely by this test)
Hypotension (low blood pressure, especially when changing positions – sometimes called orthostatic hypotension)
Postural Orthostatic Tachycardia Syndrome (POTS), where your heart rate increases a lot when you stand up.

A negative tilt table test means we didn’t see those significant changes. Your fainting might be due to something else, or it might be a type of fainting that this test doesn’t pick up.

You’ll usually get the results within a few days, if not sooner. Your referring doctor will go over them with you.

If the test is abnormal, or even if it’s normal but you’re still having symptoms, we might need to do some more investigating. This could include:

A hemodynamic test with an echocardiogram (to look at blood flow and heart pumping)
An autonomic reflex test (to check the part of your nervous system that controls automatic functions)
Vestibular function tests (if inner ear issues are suspected)
More heart rate monitoring
An echocardiogram (an ultrasound of your heart)

Take-Home Message: Key Things to Remember About Your Tilt Table Test

It can feel like a lot of information, so here are the main points:

A Tilt Table Test helps us find out why you might be fainting or feeling very lightheaded.
It involves being gently tilted on a special table while we monitor your heart and blood pressure.
Preparation is simple: usually no food for a few hours before, wear comfy clothes, and arrange a ride home.
It’s important to tell the medical team how you’re feeling throughout the test.
The test is safe, and we’re there to look after you.
The results will help us decide on the next steps in your care.