​Children's Heart Center

Tilt Table Procedure

A medical problem that can have many different causes is syncope, or fainting. Syncope may occur rarely or frequently, depending on the cause. When a physician sees a patient with a complaint of syncope, the physician will carefully evaluate the patient’s past medical history and perform a physical examination. If basic components of the examination or history do not reveal a potential cause for the syncope, and the patient has no history of heart disease or a heart condition, then further diagnostic procedures, such as a tilt table procedure, may be recommended.

Children's Heart Patient

Tilt Table Procedures are often useful in diagnosing causes of syncope such as:

  • Vasovagal syndrome – A sudden drop in blood pressure with or without a decrease in heart rate that is caused by a dysfunction of the nerves controlling the heart and blood vessels
  • Arrhythmia (or dysrhythmia) – A heart rate that is too slow, too fast or too irregular to maintain adequate blood flow to the body
  • Valve disease – Malfunction of one or more of the heart valves that may cause an obstruction of the blood flow within the heart

Performing a Tilt Table Procedure

  • The tilt table procedure attempts to identify the cause for the onset of syncope by making changes in posture from lying to standing. This is accomplished by having the patient lie flat on a special bed or table while connected to EKG and blood pressure monitors.
  • EKG, blood pressure (invasive and noninvasive) and pulse oximetry monitoring are utilized to monitor physiologic responses throughout the procedure.
  • An IV and small arterial monitoring line is placed by a doctor or nurse after the other monitoring devices are already connected – in case the IV or arterial line placement triggers a spontaneous syncope event.
  • The arterial monitoring line is to provide the ability to continuously monitor peripheral blood pressure during the procedure and to correlate it with any other physiologic events as they occur during the procedure.
  • The IV is for the purpose of administering medicine that will trigger a syncope event if the patient’s reported symptoms do not occur naturally after the first 10-15 minutes of the test. Fluids may also be delivered through the IV following the test to allow for quicker recovery in those patients that may feel unwell or have their symptoms.
  • Upon starting the tilt table test, the bed or table is elevated to an almost standing position to simulate the patient actually standing up from a lying position. The blood pressure and EKG are measured during the test to evaluate changes during the position change. The patient will stand for 10-15 minutes.
  • If symptoms do not occur after that time, a medication called Isuprel (which mimics adrenaline to increase heart rate) may be administered to obtain more information.
  • The patient will then stand for another 10-15 minutes while the medication is working. If symptoms have not arisen after 30 minutes of standing, the test will be considered completed.
  • The patient is then returned to a lying position and the medication is discontinued. Further monitoring until the patient has fully recovered from the test and is able to walk safely without assistance.