HEAD UP TILT TABLE (HUTT)
The head-up tilt table test is a way to find the cause of fainting spells.
- A tilt table test occasionally called upright tilt testing, is a medical procedure often used to diagnose syncope. Patients with symptoms of dizziness or lightheadedness, with or without a loss of consciousness (fainting), suspected to be associated with a drop in blood pressure are good candidates for this test.
- The tilt-table test is designed to detect on of the most common causes of fainting or lightheadedness, a phenomenon known as postural hypotension.
- Tilt-table testing may be done when heart disease is not suspected of being responsible for an attack of fainting (syncope) or near-syncope.
- Test can be done in different ways and be modified for individual circumstance. In some cases, the patient will be strapped to a tilt table lying flat and then tilted or suspended completely or almost completely.
You and your doctor will decide which type of valve is best for you.
The test involves lying quietly on a bed and being tilted at different angles (30 to 60 degrees) for a period of time while various machines monitor your blood pressrun, electrical impulses in your heart, and your oxygen level. Heart rhythm, blood pressure and other symptoms are closely monitored and evaluated with changes in position. The patient is completely conscioud for the test and an intravenous line is place prior to the exam. This is an outpatient procedure.
How should I prepare for the head-up tilt table test?
If you're scheduled for a head-up tilt table test, you should:
- Take all your medications as prescribed.
- Do not eat or drink anything after midnight the evening before your test.
- If you must take medications, drink only small sips of water to help you swallow your pills.
- When you come for your test, bring with you a list of all your current medications, including the dose.
- When you come to the hospital, wear comfortable clothes. It is best not to wear any jewelry or bring valuables.
- If you have diabetes, ask for specific instructions on taking your medications and eating/ drinking before the procedure.
Procedure
A tilt table test can be done in different ways and be modified for individual circumstances. In some cases, the patient will be strapped to a tilt table lying flat and then tilted or suspended completely or almost completely upright (as if standing). Most of the time, the patient is suspended at an angle of 60 to 80 degree. Sometimes, the patient will be given a drug , such as Glyceryl trinitrate (nitroglycerin) or isoproterenol, to create further susceptibility to the test. In all cases, the patient is instructed not to move. Symptoms, blood pressure, pluse, electrocardiogram, and sometime blood oxygen saturation are recorded. The test either ends when the patient faints or develops other significant symptoms, or after a set period (usually from 20 to 45 minutes, depending on the facility or individualised protocol).
Diagnostic Symptoms
A tilt table test is considered positive if the patient experience symptoms associated with a drop in blood pressure or cardiac arrhythmia. A normal person’s blood pressure will not drop dramatically while standing, because the body will compensate for the posture with a slight increase in heart rate and constriction of the blood vessels in the legs. If this process does not function normally in the patient, the test could provoke signs and symptoms ranging from minor lightheadedness to a very severe cardiac episode, depending on the person.
A common side effect during tilt table testing is felling of heaviness and warmth in the lower extremities. This is due to blood pooling in the legs and, to onlookers, the patient’s lower extremities may appear blotchy, pink or red.
Dizziness or lightheadedness are also likely to occur in susceptible patients. Tilt table testing could provode fainting or syncope; in fact, this is the purpose of the test. It may not be appropriate, or indeed even possible, to stop the test before this occurs, as the drop in blood pressure or pulse rate associated with fainting can come on in seconds. This is why the patient’s blood pressure and ECG should be continuously monitored during the test.
Dizziness or lightheadedness are also likely to occur in susceptible patients. Tilt table testing could provode fainting or syncope; in fact, this is the purpose of the test. It may not be appropriate, or indeed even possible, to stop the test before this occurs, as the drop in blood pressure or pulse rate associated with fainting can come on in seconds. This is why the patient’s blood pressure and ECG should be continuously monitored during the test.
In extreme cases, tilt table testing could provoke seizures or even cause the heart to stop. The heart resumes beating normally upon being returned to a flat or head down position. If at anytime in tilt table testing a patient loses consciousness, he or she will be retuned to a supine or head down position and will be given immediate medical attention, which could include being given fluids or perhaps atropine or a symptomatic drug like epinephrine or ephedrine which will raise blood pressure and heart rate rapidly.
