Tilt Table Testing

Common dizziness due to sudden standing up is usually due to pooling venous blood and is termed

• Supination

• Orthopnea

• Orthostatic hypotension

• Postural orthostatic tachycardia

Answer explanation

Orthostatic hypotension, also known as postural hypotension, and colloquially as "head rush" or "dizzy spell" is a form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching. The symptom is caused by blood pooling in the lower extremities upon change in body position. Iti s quite common and can occur briefly in anyone, although it is particularly prevalent among the elderly, in dehydration, and in those with low blood pressure.

Orthostatic hypotension is prevalent among

• the elderly

• in dehydration

• low blood pressure

• high blood pressure

Tags

NGSS.HS-LS1-3

is this most frequently occuring form of a larger group of neurally mediated reflex faints that also include carotid sinus syndrome and post-miturcation [urination] syncope.

Check 5 recommended things to monitor during tilt table testing.

Groups:

(a) Recommended

,

(b) Not recommended

• BP

• Transthoracic echocardiogram

• 02 sat.

• End tidal C02

• Pulse rate

• Symptoms

• EKG

• RA and RV intracardiac electrodes

• Vagal nerve activity

Answer explanation

The patient is suspended [tilted] at an angle of 60 to 90 degrees. Sometimes the patient will be given a drug, such as Glyceryl trinitrate (nitroglycerine) or isoproterenol, to create further susceptibility to the test. In all cases, the patient is instructed not to move. Symptoms, blood pressure, pulse, electrocardiogram, and sometimes blood oxygen saturations are recorded. The test either ends when the patient faints or develops other significant symptoms, or after a set period (usually 20 to 45 minutes, depending on the facility or individualized protocol)... If at any time in tilt table testing a patient loses consciousness, he or she will be returned to a supine or head down position and will be given immediate medical attention, which could include being given fluids or perhaps atropine or adrenaline.

During a tilt-table test, the angle of table should be tilted to between

• 24-40 deg

• 45-60 deg

• 60-90 deg

• 100-130 deg

Answer explanation

60-90 deg. A tilt table test can be done in different ways and be modified for individual circumstances. In some cases, the patient will be strapped to a tilt table lying flat and then tilted or suspended completely or almost completely upright (as if standing). But, most of the time, a patient is suspended at an angle of 60-80 degrees.

In all cases, the patient is instructed ​ (a)   during the tilt-table test.

• to move
• not to move

A tilt-table test is performed on a coronary patient who regularly takes nitroglycerine. What should be recommended after an initial passive tilt-table test of 70 degrees for 20 minutes fails to produce a response?

• Tilt the table to 90-110 degrees

• Continue this tilt for up to 45 minutes

• Give high dose of IV Nitroglycerine with tilt

• Give Isoproterenol (Isuprel) with tilt

• Give fluid challenge with tilt

Answer explanation

Continue this tilt for up to 45 minutes. Cohen says, "In patients who undergo tilt-table testing who have coronary artery disease, the administration of Isoproterenol is contraindicted. In those patients, a passive head-up tilt table test, which consists of 45 minutes of upright tilt testing, can be performed." Although a controlled infusion of Isoproterenol is safe in patients without heart disease, it should not be used in those with coronary artery disease since angina and serious arrhythmia can be provoked (Isuprel "whips" the heart).

In a tilt-table test, how is the patient usually monitored for hypotension?

• Skin color and temperature

• Continuous puls oximeter

• Continuous arterial line pressure

• Frequent auscultory BP

Answer explanation

Auscultatory BP every 5 minutes.

After an initial passive-tilt procedure is nondiagnostic, what medications may be given? Select the two most commonly used provocative agents.

• NTG SL

• Atropine

• Adenosine

• Edriophonium CL

• Isoproterenol (Isuprel)

Answer explanation

Zipes says, "Pharmacologic provocation remains in most laboratories, a secondary step to be used for eliciting susceptibility to hypotension-bradycardia during head-up tilt testing after the baseline drug-free tilt has been nondiagnostic. Currently, Isoproterenol and nitroglycerine are the most frequently used agents. Adenosine and edrophonium have largely be abandoned."

The head-up tilt-table test is a procedure used to provoke neurogenic syncope that is caused by a severe ​ (a)  

• Vasovagal response
• D-fiber response
• Beta adrenergic response
• Alpha adrenergic response

Answer explanation

Vasovagal response. "The most common etiologies of syncope are of a noncardio-vascular nature, with the neurocardiogenic syncope and orthostatic hypotension accounting for approximately half of all cases. In neurocariogenic syncope, there is a brain-heart interaction such that a catecholamine trigger (adrenaline) causes the heart to beat forcefully" (hypercontractile), thereby activating mechano-receptor C fiber on the posterior left ventricle.