 Tilt Table Evaluation
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A medical problem that 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:
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- Vasovagal Syndrome — A sudden drop in blood pressure with or without a decrease in heart rate which is caused by a dysfunction of the nerves controlling the heart and blood vessels.
- Arrhythmia — 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.
- Cardiomyopathy — A chronic abnormality in how the heart muscle functions.
- Myocarditis — An acute (new onset) inflammation of the heart that may trigger some cardiomyopathy.
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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.
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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. The bed or table is then elevated to an almost standing position to simulate the patient standing up from a lying position. The blood pressure and EKG are measured during the test to evaluate changes during the position changes. 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. Tilt table tests can produce fainting in some people who have never fainted, and can fail to reproduce in people with well- documented vasovagal syncope. For this reason, all tests are coordinated with a cardiologist who understands the particular details of the patients situation.
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Patients should report for the tilt test with an empty stomach, having fasted for at least eight hours. The tests are generally scheduled for the morning, so patients typically fast from the time they go to sleep until the test is completed. The physicians who perform the tilt test will review the results with you and your primary cardiologist. 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.
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Contact Children's Hospital Boston Cardiovascular Program physicians for a second opinion.
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