Upright Tilt Test: What it is, Risk Factors | National Heart Centre Singapore

Upright Tilt Test - What it is

The upright tilt test is used to detect recurrent syncope (fainting) of unknown origin. A common form of syncope is called a simple faint or vasovagal syncope, i.e. fainting due to abnormally sensitive reflexes in the cardiovascular system during prolonged standing or when subjected to unpleasant stimuli.

Although this form of faints may appear alarming, they are rarely life-threatening. The test requires you to be tilted in an upright position to simulate a situation of prolonged standing and you will be continuously monitored to see if this will reproduce the symptoms of recurrent fainting.

Upright Tilt Test - Other Information

Is the test safe?

Risks of a tilt table testing are low, but may include:

Hypotension, a significant drop in blood pressure
Bradycardia or pauses, a drop in heart rate to less than 40 bpm (beat per minute)
Dizziness
Nausea
Faint
Headache
Chest discomfort
Palpitations
Seizures and fits

Please be assured that there is a doctor present at all times to tend to you if any situation arises. An informed consent will be required before the start of the test.

Can I undergo the test if I am not feeling well?

If you are not feeling well because of fever, running nose or acute illness, you should not undergo the upright tilt test. Please call the NHCS Call Centre at +65 6704 2000 to reschedule the test.

Preparations before test

Fasting is required for this test. No food and drinks (including water) at least 6 hours before the test.
Do not apply lotion, oil or powder to the chest.
For males, please shave your chest before coming so that the ECG electrodes can be placed on your chest.
Check with your doctor if you are required to stop any of the cardiac or asthmatic medication you are currently taking.
Informed consent prior to the test is required. For patients below 21 years old, please be accompanied by a parent for consent taking.

How is the test done?

Before the tilt test starts, a doctor will assess to ensure that you are fit for the test. Thereafter, the Cardiac Physiologist/Technologist will place the electrocardiogram (ECG) electrodes on your chest, blood pressure cuffs on your hand and finger. An intravenous cannula will be inserted into a vein on your hand via an injection. This injection is necessary so that in the event of an emergency, we can inject life-saving medication via this intravenous access. You will then be strapped onto a motorised tilt table with foot support, after which you will be tilted to a certain pre-determined angle. At all times, your heart rate, blood pressure and heart tracing will be continuously monitored.

There are 3 stages to this test:

Stage 1

Finger pressure will be applied to your artery of the neck (carotid artery), first on the right side and then on the left side (carotid sinus massage).

Stage 2

The table will be tilted upright to an angle of 60-70 degrees. You will remain in that position for up to 30 minutes. During the test, your ECG will be monitored continuously and your blood pressure and pulse rate will be measured at a 5-minute interval.

Stage 3

Upon completion of Stage 2, a single dose of a drug called Glycerin Trinitrate (GTN) will be sprayed under the tongue. Alternatively, another drug called isoprenaline will be given via the intravenous access obtained earlier. You may experience some palpitations (strong and rapid heart beating) or a mild headache which are some common side effects of this drug. These side effects are generally short acting and you will recover without the need to administer other drugs. This stage will last about 15 minutes.

This test will be terminated as soon as you experience giddiness or are about to faint. If no symptoms occur, the test will be stopped at the end of 45 minutes.