Overview

We do a tilt table test to find why you might feel dizzy or light-headed, or lose consciousness. This can help us to treat your symptoms.

A tilt table is an examination couch that can slowly tilt up and down while you lie on it. The couch moves you slowly from a lying position to a near standing position. You do not have to move yourself.

The aim of a tilt test is to make your symptoms happen in a safe environment. We can then check if these symptoms are connected to changes in your heart beat or blood pressure.

The test can also help us to understand how your autonomic nervous system is working. This is the part of your brain that controls some of the processes in your body, such as blood pressure. 

If you're over the age of 40, the test might also include massaging an area of your neck. This is called a carotid sinus massage.

Preparing for your tilt table test

It is very rare to lose control over your bladder or bowels during a tilt table test. However, you may want to go to the toilet before the test and only have a light breakfast.

You might want to ask somebody to take you home. During the test, you may have temporary loss of consciousness and a headache. You may not be fit enough to drive after the test (or be legally prevented from driving as a result of the test) for a time.

Some people prefer not to use public transport after the test. This is because they may have side effects, such as:

• weakness
• tiredness (fatigue)
• sweating

Carotid sinus massage

If you're over 40 years old, your test might include having an area of your neck massaged. The carotid arteries are two large blood vessels in your neck. They supply your brain with blood on either side. 

When we massage your carotid arteries, we can see if your brain responds normally. This tells us if your symptoms are linked to your blood pressure or heart rate dropping.

We ask you to lie on the tilt table. For your protection, we strap you to the table at your thighs and hips. This is to prevent you from falling and injuring yourself if you faint during the test.

First, we massage your right artery while you lie down. Then we tilt the couch a bit more upright. We repeat the massage on the right side and then on the left.

Sometimes, people find the pressure to the carotid sinus (side of the neck) painful. It can cause dizziness or fainting (loss of consciousness). During the test, we measure your heart rate and blood pressure continuously. We check if your symptoms are linked to your heart rate or blood pressure dropping. 

If you do not feel dizzy or faint, we usually continue with the next part of the test. 

Read more about the risks of carotid sinus massage.

During the tilt table test

A tilt table is an examination couch that can slowly tilt up and down while you lie on it. There are foot rests to prevent you from sliding off the couch. You are also supported with safety straps and a table in front of you.

The couch slowly moves you from lying down to a near standing position. You stay upright on the tilt table for between 10 and 40 minutes. This is because some people only feel dizzy or faint after they have been upright for a while.

Throughout the test, we record your blood pressure and heart beat. Some people find the finger cuff device that measures their blood pressure uncomfortable.

Please tell us about any symptoms that you get. We can then record these too.

GTN mouth spray

If you still do not feel dizzy or lose consciousness, we will give you a mouth spray. This lowers your blood pressure. It mimics the sudden drops in blood pressure that happen naturally during everyday events. For example, our blood pressure can drop if we suddenly hear bad news or have pain.

The mouth spray is called GTN (glyceryl trinitrate). It can cause dizziness, or near or full loss of consciousness. We then monitor you closely for another 15 minutes.

Some people find the taste of GTN spray sharp and unpleasant, but this taste should only last a short time. The main side effect of the GTN spray is a headache. 

Read more about the risks of GTN spray.

Tilt table testing with brain wave monitoring (EEG)

Sometimes, the doctor who referred you for the test asks us to do brain wave (EEG) monitoring. This is in addition to the standard monitoring of your blood pressure and heart rate.

We will ask you to come to meet with the EEG physiologists 1 hour before your tilt table test appointment. This will be in the same location as your tilt table test.

The physiologists will measure your head. They will then attach small metal disks called electrodes on to your scalp by using some sticky paste.

Once the electrodes are in place, they will accompany you to the tilt room. You will have a standard tilt test, but with additional brain wave and video monitoring as well.

Finishing the test

If you have no symptoms, the test is finished. We bring the table back into a flat (horizontal) position and remove the straps and monitoring equipment. 

If you faint at any time during the test, we will stop the test immediately. Please tell us if you feel dizzy or faint or get any other symptoms. This is particularly important if you have symptoms that were the reason for you seeing your doctor or specialist.

You might want to sit in the waiting room for a while and drink some water after the test.

Sometimes, we give you fluids by mouth or through a vein after the test. This improves your blood pressure before you leave. Very rarely, you might need to stay in a hospital bed.

After you leave hospital

Most people feel well after the tilt test and can return home or to work, especially if the test is normal. However, some people need to rest at home for a while afterwards.

After the test, you might:

• feel dizzy or light-headed
• have a headache, sometimes for a few days afterwards

This is common if you have been very tired or had low energy with dizziness and low general stamina (with or without blackouts). Rarely, you might get side effects like this even if you have not been getting these symptoms.

We recommend that you drink water and keep well hydrated after the test. 

Risks of tilt table testing

The test is designed to make your symptoms happen in a safe, controlled environment. This means that you may feel faint or lose consciousness during the test. We do our best to stop the test when it is clear that you are about to lose consciousness.

Even if your doctor arranged the test because of dizzy spells or light-headedness, you may still lose consciousness fully during the test. 

After fainting, you can often feel sick (nausea). Sometimes, you may also be sick (vomit), sweat or feel dehydrated. More rarely, you may lose control over your bladder and bowels during the test.

Another possible complication is low blood pressure and heart rate for a long time. We might need to replace the fluids in your body through a thin tube called a cannula into a vein. You might need to tilt your head down temporarily and raise your legs to improve your blood pressure.

Very rarely, if you lose consciousness and have a short seizure or fit, you may move against the supporting straps with force. This can cause mild bruises and discomfort later.

Risks of GTN spray

The main side effect of the GTN spray is a headache. Usually, this only lasts for up to a few hours. Some people may have a headache for longer. GTN can also cause:

• an irregular heart rhythm
• temporary lack of energy
• temporary low blood supply to the brain
• dizziness
• drowsiness (sleepiness)
• flushing (when your face becomes red and hot)
• low blood pressure
• nausea (feeling sick) and vomiting (being sick)
• temporary loss of consciousness because of reduced blood supply to the brain for a short time (similar to fainting) 

Risks of carotid sinus massage

If you have a carotid sinus massage, there is a very low risk of a stroke (0.24%). This is a serious condition, which might be disabling.

If you prefer not to take this risk, please tell us. We will then not do the carotid sinus massage. You can still have the rest of the test.

Giving your consent (permission)

We ask if you agree (consent) to have the test when you arrive at the hospital. First, we give you the chance to ask questions.

If we offer treatments during the test, we will ask for consent to talk about these treatment options with you.

Most of the treatments that we suggest are not based on medicine. They may include treatments based on yoga and mindfulness (a type of meditation when you pay attention to the present moment). If you would prefer us not to offer you these newer treatments, please tell the person doing your test (the tilt operator).

Otherwise, you can come to the outpatient clinic to talk about treatment options there. You can also discuss your treatment options with the specialist doctor who referred you for the test.

Other possible tests

There are currently no other tests that you can have instead of a tilt table test.

If your doctor suspects that the main problem is with your heart rather than with controlling your blood pressure, they may suggest heart tests. For example, you may have heart rhythm monitoring. This may show some of the heart rhythm problems that the tilt test can provoke. These problems can also happen without warning in your everyday life.

Follow-up appointment

If a specialist outside of the hospital referred you for the test, you usually have a follow-up appointment with their service.

If your GP or the acute medical services at St Thomas' Hospital referred you, we usually give you a follow-up appointment when needed. Generally, if you have been fainting, we give you advice only. We do not arrange a follow-up appointment, unless your symptoms are severe and you are fainting often.