Tilt table procedure

A medical problem which can have many different causes is syncope (fainting). Syncope may occur rarely or frequently, depending on the cause. Some causes of syncope may include, but are not limited to, the following:

• 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 may cause an obstruction of the blood flow within the heart

When a physician sees a child with a complaint of syncope, the physician will carefully evaluate the child'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 child has no history of heart disease or a heart condition, then further diagnostic procedures, such as a tilt table procedure, may be scheduled.

What is 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 done by having the child lie flat on a special bed or table while connected to EKG and blood pressure monitors. A sticker will be placed on the forehead to measure the blood flow to the brain and an IV will be placed by a nurse. The IV allows for potential administration of a medicine if patient’s 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 Isoprel (stimulant/fake adrenaline to increase heart rate) may be administered to obtain more information. Your child 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 over. The patient will be placed back in a lying position and the medication will be turned off. Further monitoring and recovery will take place following the test. If the test causes an episode of syncope, then the probable cause of the syncope is vasovagal syndrome. The physician can then prescribe specific treatment for the syncope once the cause is known.

If the test does not cause an episode of syncope, and/or the EKG and blood pressure recordings do not detect an abnormality, then additional tests or procedures may be scheduled to gather further diagnostic information.