Head-up Tilt Test

What is Head-up Tilt test?

Head-up Tilt Test is a specialized noninvasive test performed to evaluate fainting spells. This test in particular helps to diagnose or rule out one of the commonest causes of faint, the vasovagal or neurocardiogenic syncope.

It is indicated when a patient has been experiencing “fainting spells”.

What are pre-test instructions?

  • 6 hours fasting prior to the test is essential.
  • One can take his/her regular morning medications with a sip of water.
  • One should carry all their previous investigations along with them.

How is the test performed?

Patient is made to lie down on a bed that can be moved from a horizontal to a near-vertical position in a warm, dim-lit room. Patient’s body is covered with bedsheets to keep patient warm and he/she is strapped to the bed. Three electrodes are attached to the body and the ECG is being continuously recorded on a monitor. The bed is then tilted up to almost 80 degrees vertical and the ECG is monitored continuously and the BP recorded every 2 minutes for 20-30 minutes. Patient is also monitored for any faint like symptoms or nausea or dizziness. Patient should alert the doctor if he/ she experiences any of these symptoms. If the test is not conclusive, patient is then tilted back to horizontal position and small dose of sorbitrate tablet is administered under the tongue. After provocation with the medication, the test is repeated again. On completion of the test, patient is tilted back to horizontal position and allowed to rest for 15 minutes. Patient is given water and then patient can have food and tea or coffee after 5-10 minutes.

During the test, patient can experience faint like symptoms and can actually faint, at which time the heart rate, blood pressure and heart rhythm are monitored. Most often in patients with neurocardiogenic syncope, a fall in heart rate and blood pressure are noted, which revert to normal as soon as the patient is tilted back to horizontal and the patient feels better symptomatically immediately.

What are the risks or complications?

Usually the reproduction of the faint attack during the test is very transient and does not lead to any complications and the chances of asystole (cardiac arrest) or any other life-threatening arrhythmias is almost unknown. All the necessary resuscitative equipment consisting of drugs, external pacer and a defibrillator are readily available in the test room.

What happens after the test?

The report would be given to patient in about 30 minutes and then patient is allowed to carry on with the regular activities. Patient might experience generalized weakness for a period of few hours to a day, which does not require any active treatment and is self-limiting.

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