• Evaluation of syncope of uncertain origin.
• Evaluation of symptoms suggestive of autonomic dysfunction, such
• Atypical seizures.
• Orthostatic symptoms.
• Distinguish between psychosomatic and neurally mediated symptoms.
• Complete heart block or profound bradycardia
• Significant left or right ventricular outflow obstructive lesions.
• Generally not performed in patients with structural heart disease
and syncope, unless all other testing, including invasive electrophysiology
testing, is unrevealing.
• Tilt table: Motor-driven table, capable of 70-degree
• Monitoring for continuous heart rate and blood pressure recording.
• Intravenous access.
• Resuscitation equipment, including medications and cardiac defibrillator.
• Most episodes of vasovagal or neurally mediated
syncope can be elucidated by careful history of the events surrounding
• Tilt-table testing does not provide additional useful information
for most straightforward cases of vasovagal syncope.
• Tilt-table testing is helpful in the following settings:
• Recurrent syncope of uncertain etiology.
• Syncope without prodromal symptoms.
• Patients with normal electroencephalogram and a diagnosis of
a seizure disorder.
• Symptoms occurring while standing.
• Patients with syncope should have an ECG performed to exclude
possibility of long QT syndrome.
• During standing, with decreased filling of ventricular chambers,
C-reactive fibers in myocardium are stimulated and initiate afferent
response to brain.
• In response, neural reflex is initiated with drop in blood pressure
or heart rate, or both.
• Patients with neurally mediated syncope have profound decrease
in blood pressure or heart rate or both, resulting in the following:
• Abdominal discomfort.
• Syncope (often).
• With profound hypotension or asystole, patient may experience
seizure due to cerebral hypoperfusion.
• Obtain intravenous access.
• Monitor heart rate and blood pressure in baseline state while
patient is supine.
• Slowly raise table to 60–80-degree angle.
• Patient remains in this position for 15–60 minutes, depending
• Test is terminated promptly if significant symptoms develop.
• Return the patient to the supine position at end of baseline testing
or when significant symptoms develop.
• Test may be repeated with pharmacologic challenge, usually isoproterenol
infusion of 1–3 mcg/min.
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