Tilt Table Testing, 2024, William P. Cheshire, MD et al

Case

A 43-year-old woman presented with a 1-year history of recurring symptoms of sudden onset of fatigue, palpitations, dyspnea, chest pain, lightheadedness, and nausea that were associated with standing and resolved with sitting. These symptoms began 1 month after mild COVID-19 infection.

At presentation, while supine, blood pressure (BP) was 123/70 mm Hg and heart rate (HR) was 90/min; while seated, BP was 120/80 and HR was 93/min; after standing for 1 minute, BP was 124/80 and HR was 119/min. Physical examination results were normal. Oxygen saturation was 98% at rest while breathing room air. She had no oxygen desaturation during a 6-minute walk test but walked only 282 m (45% predicted).

Complete blood cell count, morning cortisol, and thyrotropin blood levels were normal. Electrocardiogram (ECG), chest computed tomography, pulmonary function testing, methacholine challenge, bronchoscopy, echocardiography, and cardiac catheterization findings were normal. During tilt table testing, the patient experienced lightheadedness and nausea when moved from horizontal to the upright position. Results of the tilt table test are shown in the Table and Figure.

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Clinical Bottom Line

• Tilt table testing is a procedure in which blood pressure, pulse, and electrocardiography are continuously monitored as a bed moves rapidly from a supine to a vertical (head-up) position.
  
  
• Tilt table testing is useful for evaluating patients with syncope of unknown cause, suspected vasovagal or orthostatic syncope, and/or autonomic dysfunction, including orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS).
  
  
• Tilt table testing confirms the diagnosis of POTS in individuals who have symptoms of orthostatic intolerance (eg, lightheadedness, palpitations) without orthostatic hypotension and an increase in HR of ≥30/min or ≥40/min (in those aged 8-19 years) within 10 minutes of head-up tilt.
  

 

Not all tilt table testing is the same. The methodology and conditions of the test depend on the clinical question being asked. Interpretation requires an understanding of physiology and what defines normal and abnormal values.
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