17043 Tilt Table Test

Overview

A tilt table test is a safe, painless test that helps doctors find out why someone keeps fainting or feeling dizzy. You lie on a special bed (the tilt table) that slowly tilts you from lying flat to standing upright. While this happens, a machine watches your heart rate and blood pressure. The test shows how your body copes with changes in position. Some people faint because their blood pressure or heart rate drops suddenly when they stand up. The tilt table test can often recreate that moment in a safe place, so your doctor can see what is going wrong and plan the right treatment.

Fainting is very common — about 1 in 3 people faint at some point in their life. The tilt table test itself is a routine specialist test, done in heart (cardiology) or nerve (neurology) clinics in most hospitals.

The test can be done on adults and on children old enough to cooperate, usually from around 6 to 8 years upwards. It is most often used for teenagers and adults who have repeated fainting or dizziness, and for older adults who faint without warning. Your doctor will decide if it is suitable for you.

Symptoms

Common symptoms

• Fainting or blacking out, especially when standing up or standing still for a long time
• Feeling light-headed, dizzy or 'spaced out' after standing
• Blurred or greyed-out vision before a faint
• Feeling sick, hot or sweaty just before fainting
• A fast pounding heartbeat or a slow heartbeat around the time of a faint
• Feeling very tired or washed out for a while after fainting
• Fainting triggered by heat, crowded places, standing in a queue, or the sight of blood

Symptoms in children

• Fainting in a warm room, at assembly, in the shower, or while standing still
• Going pale and clammy before a faint
• Brief jerking movements during a faint, which can look like a seizure but are common in young people who faint
• Being very tired or emotional afterwards
• Often a family history of fainting in a parent or sibling

Symptoms in older adults

• Fainting with little or no warning, which raises the risk of a fall
• Dizziness or unsteadiness when getting up from a chair or bed
• Faints that happen after meals or after standing up quickly
• Faints that happen while lying down, which need checking urgently
• Confusion or memory of events being patchy after a blackout

Causes

Main causes

• Reflex (vasovagal) fainting — a sudden drop in heart rate and blood pressure set off by standing, heat, emotion or strain
• Postural hypotension — blood pressure falls when you stand up, so less blood reaches the brain
• Postural tachycardia syndrome (PoTS) — the heart rate jumps abnormally when standing, causing dizziness and tiredness
• Heart rhythm problems, heart valve problems or other heart conditions
• Side effects of medicines that lower blood pressure or affect the heart
• Dehydration, low salt levels in the body, or being very unwell with another illness
• Nerve damage (for example in diabetes) that stops blood vessels tightening when you stand

Risk factors

• A previous history of fainting, especially as a teenager
• A family history of fainting
• Long periods of standing, hot weather, hot baths, or crowded rooms
• Being dehydrated or not eating enough
• Pregnancy
• Being older, or taking several medicines for blood pressure
• Diabetes or other conditions that affect the nerves
• Being very fit and having a naturally slow resting heart rate

When to see a doctor

See a doctor urgently if:

• You faint and injure yourself, or faint and cannot remember what happened
• Fainting happens during exercise, with chest pain, or with a racing heartbeat
• You faint while lying or sitting down
• Someone in your family died suddenly at a young age, or has a known inherited heart condition
• You are pregnant and fainting repeatedly

Book a routine appointment if:

• You have fainted once or twice with no injury and want to understand why
• You feel dizzy or light-headed most times you stand up
• You have been offered a tilt table test and want to talk it through first
• Fainting is making you anxious or affecting work, school or driving
• You want advice on how to reduce your chances of fainting again

Diagnosis

Your doctor starts by listening to your story: what you were doing, what you felt just before, and how you felt afterwards. Someone who saw you faint can give very useful details. Your doctor will check your pulse, blood pressure lying and standing, and listen to your heart. Tests such as an ECG (a tracing of your heart's electrical activity) are usually done first. The tilt table test is offered when the cause is still unclear, or when the doctor suspects a reflex faint or a problem with blood pressure or heart rate on standing.

Tests that may be done

• Medical history and physical examination, including blood pressure checked lying down and after standing
• Electrocardiogram (ECG) — painless sticky patches record your heart's electrical rhythm
• Heart rhythm monitoring at home for a day or longer, to catch an abnormal rhythm
• Blood tests to check for anaemia, salt balance, blood sugar and other causes
• Echocardiogram — an ultrasound scan of the heart, if a heart problem is suspected
• Active stand test — blood pressure and heart rate measured while you stand still for several minutes
• Tilt table test — the table tilts you upright while your heart rate and blood pressure are recorded

What to expect at your appointment

You will usually be asked not to eat for a few hours before the test, though you can normally sip water. You may be asked to stop certain medicines for a day or two beforehand, but only if your doctor tells you to — never stop medicine on your own. On the day, you lie flat on the table and soft straps keep you safe. A blood pressure cuff and heart monitor are attached. The table tilts you to an almost-standing position for up to about 45 minutes while staff watch your readings. If you feel faint or your readings change, the table is lowered flat at once. Sometimes a spray or a small amount of medicine is used under the tongue to make a reflex more likely — your nurse will explain this first. You can ask to stop at any time. Afterwards you rest for a short while and are usually able to go home, though it is wise to have someone with you and not to drive yourself.

Treatment

The tilt table test is not a treatment — it is a way of finding the cause so that the right treatment can be chosen. What happens next depends completely on the result. Many people have a harmless reflex faint and improve with simple changes to their daily routine. Others need help with blood pressure, heart rate or another condition, and some need no treatment at all beyond reassurance and advice.

Self-care at home

• Drink enough fluid each day — pale yellow urine is a good sign you are well hydrated
• Stand up in stages: sit on the edge of the bed for a moment, then rise slowly
• Learn physical counter-manoeuvres: cross your legs and squeeze, clench your fists, or tense your arms and legs when you feel a faint coming on
• Sit or lie down as soon as you notice warning signs like feeling hot, sick or greyed-out vision
• Avoid long periods of standing still — shift your weight, or walk on the spot
• Take it easy in hot baths, saunas and crowded warm rooms
• Eat regular meals and avoid skipping breakfast
• Tell someone nearby if you feel unwell, so you can sit down safely

Medical treatments

Treatment is tailored to the cause found. For reflex faints, the main approach is advice, hydration, and learning to recognise and act on warning signs; some people are taught a programme of supervised exercises to build tolerance to standing. If blood pressure drops on standing, your doctor may review your existing medicines and may prescribe treatment to support blood pressure or help your body hold on to salt and water. If the heart rate is too fast or too slow, or a heart rhythm problem is found, a heart specialist will discuss the options with you. Compression stockings fitted by a professional can help some people. Your doctor will explain the choices, the benefits and the drawbacks, and you should always follow their advice rather than changing anything yourself.

When is surgery considered?

Surgery is not usually part of treatment for fainting. In a small number of people with a very specific pattern of reflex faints and a slow heartbeat, a heart specialist may discuss fitting a small implanted device (a pacemaker) that keeps the heart rate from dropping too low. This is only considered after careful testing and discussion.

Living with this condition

Most people with faints live full, normal lives once they know their triggers and what to do. Learning your early warning signs is the single most useful skill — it gives you time to sit or lie down before you fall. Tell friends, family and colleagues what to do if you faint: lie you flat, raise your legs, and give you space. If you drive, ask your doctor whether the rules in your country mean you need to pause driving while tests are being done.

Lifestyle tips

• Keep a simple diary of faints — what you were doing, how you felt, and how long it took to recover
• Carry a water bottle and drink regularly through the day
• Avoid standing still for long periods; bend your knees or move your legs if you must stand
• Be careful getting out of a hot bath or shower
• Wear loose, comfortable clothing in warm weather
• Avoid skipping meals, and limit alcohol, which can make dehydration worse
• Tell your doctor about all medicines you take, including anything bought over the counter

Diet and exercise

Regular meals and steady fluid intake make a real difference. Some people are advised to take a little more salt in their diet, but only if their doctor recommends it — extra salt is not safe for everyone, particularly people with high blood pressure, heart failure or kidney problems. Gentle regular exercise such as walking, swimming or cycling helps circulation and overall fitness. Some specialist clinics teach supervised exercise programmes for people who feel dizzy on standing, starting slowly and building up over weeks. Avoid sudden hard bursts of exercise in the heat if that is a trigger for you.

Mental health and emotional wellbeing

It is very common to feel anxious after a blackout, especially if you fell or if it happened in public. Some people lose confidence and start avoiding places or activities. That fear is understandable, and it usually eases once you understand the cause and have a plan. Tell your doctor if worry is stopping you from going out, working or sleeping — talking therapies and support groups help many people get back to normal life. If you ever feel overwhelmed or hopeless, please reach out to a local mental health service or crisis line in your country straight away; you deserve support.

Prevention

A tilt table test cannot be prevented — it is a test, not an illness. But the fainting it investigates can often be reduced. Staying well hydrated, eating regularly, rising slowly, avoiding long periods of standing still and acting quickly on warning signs prevent many faints and, importantly, the injuries that can come with them.

Screening programmes

There is no general screening programme for fainting. However, if someone in your family has a known inherited heart condition or died suddenly at a young age, tell your doctor — they may recommend a heart check for close relatives. People with diabetes should keep up their routine checks, as nerve damage can affect blood pressure on standing.

Complications

If left untreated

• Injuries from falling, such as fractures, head injury or cuts
• Loss of confidence, avoidance of activities, and impact on work, school or driving
• Anxiety or low mood linked to the fear of fainting again
• Rarely, a serious heart rhythm problem that has not yet been recognised
• In older adults, longer stays in hospital or loss of independence after a fall

Long-term outlook

The outlook is good for most people. The most common cause — a simple reflex faint — is not dangerous in itself, and most people improve with hydration, trigger awareness and small changes to daily habits. If a heart rhythm or blood pressure problem is found, treatment can usually control it well. The tilt table test often brings relief, because it turns a frightening mystery into something you and your doctor can understand and manage together.

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