Head-Up Tilt-Table Testing

1. Indications
   1. Suspected Orthostatic Hypotension without obvious cause
   2. Physical limitations preclude standing vital signs
   3. Autonomic disorder monitoring of therapeutic response
2. Procedure: Preparation
   1. Perform test in quiet, comfortable room
   2. Rest supine for 5 minutes before test
   3. Attach automatic Heart Rate monitoring
   4. Attach automatic Blood Pressure monitoring and set for desired interval
3. Procedure: Tilting
   1. Start after obtaining baseline Heart Rate and Blood Pressure while lying supine for 5 minutes
   2. Slowly Tilt Table from supine to 60-80 degrees nearly upright position
   3. Obtain Blood Pressure and pulse after in upright position for 3 minutes
4. Interpretation
   1. Normal test (negative test)
      1. Diastolic Blood Pressure increases >20mmHg
      2. Heart Rate increases by 10-15 bpm
   2. Orthostatic Hypotension
      1. Systolic Blood Pressure drops >20mmHg or
      2. Diastolic Blood Pressure drops >10mmHg
   3. Dysatonomia
      1. Immediate and persistent drop in systolic and diastolic Blood Pressure
      2. Heart Rate does not increase to compensate
   4. Neuro-cardiogenic Syncope
      1. Onset after 10 minutes of testing
      2. Sudden drop in Blood Pressure results in symptoms
      3. Paradoxical Bradycardia accompanies the Blood Pressure drop
   5. Postural orthostatic Tachycardia syndrome (POTS)
      1. Heart Rate increases at least 30 beats per minute or
      2. Heart Rate increases over 120 and persists
5. References
   1. Lamarre-Cliche (2001) CMAJ 164(3): 372-6