Tilt Test – indications
Tilt test is a relatively easy method which proved very useful in evaluating patients with syncope.
- Patients with recurrent syncope or with a single syncopal episode trauma without organic heart disease or without specified etiology of syncope.
- Evaluation of patients in whom the etiology of syncope was precise, but in which a neural mediated syncope can influence the outcome.
- Patients with syncope during exertion.
The Tilt test is performed in the morning, preferably between hours 9-11, the patient having fasted and not having taken any treatment which could influence the autonomic nervous system. He is seated on a special table, fitted with an electric motor that allows it to tilt to specific angles. After a period of 10 minutes in supine position, the table is inclined to 70 degrees for 30-45 minutes.
The patient is connected to one or two belts to avoid falling. Every 3-5 minutes, the arterial tension and heart rate are measured. Continuous monitoring of the patient is currently practised, including ECG. An electrocardiogram is recorded in case of syncope. In case of negativity, the test can be sensitized by the administration of sublingual nitroglycerin or infusion.
- Normal answer, no syncope
Normally, the tilt to 60 degrees after a period of supination, results in an increase in heart rate by 10-15 beats per minute, and the blood pressure increases by 5-10 mmHg, possibly with a very slight increase in systolic blood pressure. In this case, the test is considered negative.
2. Abnormal replies with syncope
Type I: mixed
Heart rate initially increases and then decreases, but not under 40b / minute, or falls below 40b / minute for at most 10 seconds, or asystole <3 seconds. Arterial blood pressure increases initially, then decreases before decreasing heart rate.
Type 2A: cardioinhibitory
The heart rate initially increases and then decreases under 40b / minute, more than 10 seconds, or asystole> 3 seconds. Arterial blood pressure increases initially, then decreases before decreasing heart rate.
Type 2B: cardioinhibitory
Heart rate initially increases and then decreases under 40b / min, more than 10 seconds, or asystole> 3 seconds. Arterial blood pressure increases initially, then decreases to a level below 80 mmHg, simultaneously or after rapid and severe decrease in heart rate.
Type 3: vasodepressor
The heart rate gradually increases and does not decrease by more than 10% during syncope. Blood pressure drops causing syncope.