Glossary

Transesophageal Echocardiogram (TEE) uses a probe which passes down through the esophagus instead of being moved over the outside of the chest wall.  TEE shows clearer pictures of your heart, because the probe is located closer to the heart and because the lungs and bones of the chest wall do not block the sound waves produced by the probe.  A sedative and an anesthetic applied to the throat are used to make you comfortable during this test.

What is a Tilt Table Test?

Simply put, it’s a test where you lay on a table that’s a lot like a gurney, strapped to that table (for your own safety), and then periodically tilted nearly vertical (head up), and then back down. During the test all of your vital signs are closely monitored, including blood pressure and heart rate and rhythm.

Why Do I Need a Tilt Table Test?

If you’ve been experiencing dizziness, lightheadedness or syncope (loss of consciousness), and the reasons for your symptoms are not obvious to your doctor, your doctor may order this test to help assess the severity of your symptoms as well as finding a potential cause. The purpose of the test is to see if changes in body position produce symptoms such as an arrhythmia, syncope or near-syncope due to a change in blood pressure, all signs of orthostatic intolerance.

Normally, when a person stands up from a supine (laying) position, there is a small drop in blood pressure, which the body compensates for by increasing heart rate and constricting the blood vessels in the legs. Certain conditions prevent the body from making these kinds of adjustments, occasionally resulting in loss of consciousness.

Is a Tilt Table Test Dangerous?

It should be understood that uncontrolled loss of consciousness can be extremely dangerous. Driving a car, using stairs, lifting a small child and operating heavy machinery (among other things) can all be dangerous to you and those around you if you are susceptible to unexpected losses of consciousness. Being in a hospital with a trained medical professional constantly monitoring your vital signs is about the safest place you can be if you lose consciousness. Some arrhythmias that have occurred during tilt table tests can also be dangerous, but again, inside a hospital is the safest place to be if they’re going to occur, where treatment can be initiated immediately upon experiencing symptoms.

While experiencing a dangerous arrhythmia is unlikely, pre-existing ischemia makes that event more likely.^[1]

How Do I Prepare for a Tilt Table Test?

Most commonly a patient is asked to fast before a tilt table test. Your doctor may instruct you to stop taking certain medications prior to the test. To be prepared you may also want to bring along a list of any medications you are taking.^[2]

One of your arms will have a blood pressure cuff placed around it for the duration of the test and you may also have an IV line inserted for the administration of isoproterenol, a drug designed to make you more susceptible to the test. The IV line may also be used to quickly administer other medications in the case of an adverse reaction.

You may also be instructed to have someone drive you to and from the hospital for the test.

I Had a Positive Tilt Table Test. Now What?

The good news is, now your doctor has more information from which to base a diagnosis and begin treatment. Some of the reasons you may have had a positive tilt table test result include:

• vasovagal or neurocardiogenic syncope - a benign condition that is not life threatening except for the injuries you may sustain when unconscious.^[3]
• diabetic autonomic neuropathy - an autonomic nervous system disorder that causes orthostatic hypotension (positionally mediated low blood pressure). ^[4]
• Shy-Drager syndrome - also an autonomic nervous system disorder ^[4]

Beta blockers are often prescribed to treat patients after a positive tilt table test; the beta blocker prevents the heart rate from climbing too quickly and the parasympathetic nervous system from responding to that heart rate increase by slowing the heart down so much that the patient passes out.^[5][6]

Celebrity note: Greg Page, better known as the Yellow Wiggle of The Wiggles, had to stop performing due to his orthostatic intolerance.^[7]

References

Tilt table test image courtesy of Columbia University Medical Center, Division of Cardiology

Trigeminy is a term used to define a heart rhythm where two normal heartbeats are followed by a premature beat, then (usually) a compensatory pause, with the cycle repeated over and over. In text form the rhythm could be described as “BEAT beat-skip …pause… BEAT beat-skip …pause… BEAT beat-skip …pause… ”

The term trigeminy is used to describe both PACs and PVCs, but is much more commonly used to describe PVCs, and is usually assumed to be referring to premature ventricular contractions, where if the premature contractions are originating in the atria, they will often be described as “trigeminal PACs.”

On the electrocardiogram (ECG or EKG) below you can see trigeminal PVCs, a repeating pattern of two normal sinus beats followed by a premature ventricular contraction.

Thanks to Lisa33167 for the EKG