The tilt table used in cardiology

The angle of the tilt table used in cardiology is inclined to find the cause of a certain type of severe dizziness or fainting.  The use of the tilt table test tilt to cause syncope with Finnish research is old, but as a method of syncope vasovagal diagnosis in clinical practice began in 1986.

The proof of the inclined table is used mainly to know whether the vasovagal syncope is the cause of fainting and investigate other possible causes. Basically, the proof of the inclined table is based on inducing a vasovagal reaction rate in the patient.

The vasovagal syncope is usually found in patients who at first had what would be considered normal response but show an inability to maintain blood pressure as well as cerebral perfusion abnormalities caused by autonomic regulation. The percentage of positive results of tilt testing in patients with syncope ranged on average between 26% and 75% of cases.

The vasovagal syncope should not be mistaken for orthostatic hypotension which is recorded during the test by an almost instant drop in blood pressure immediately as the patient is placed upright. If blood pressure drops too low, there is no blood flow to the brain and the person faints. When a person faints they are placed immediately in a horizontal position so it is easier for the blood to reach the brain and the person wakes.

Ask the patient to lie on a special table with the ability to tilt and restrain them by safety belts both in the chest by the legs, just as it is used for a person who has damaged his spinal cord. This table allows the patient to a full horizontal position to a vertical position overall, with no exfuerzo for him.

You insert an intravenous catheter in one arm and a cuff for measuring blood pressure in the other, and then put a series of electrodes on the chest to monitor heart rate with a device for obtaining electrocardiograms electrocadiógrafo at any time of the test and heart and the answer in real time. Initially, the patient is lying face up on the table in a horizontal position. Then the doctor will tilt the table until the patient’s head is upright, between 60 and 80 degrees and remains so for 20 or 30 minutes with monitoring of heart rate and blood pressure before returning to the horizontal position.

In this initial period (Phase I) no drugs are used at any point. At this stage the patient should inform the doctor if they have the same symptoms before fainting. If at the end of this stage there were no clinical symptoms or abnormal blood pressure or heart rate, the patient returns to the supine and starts a second phase in which it is used a pharmacological provocation (Phase II) usually Isuprel (isoproterenol chloride is a bronchodilator that acts as a sympathomimetic amine) is applied to the patient via venous or sub-lingual nitrates partners back to the same degree of inclination of the first phase.

According to the patient responds and the results obtained with the diagnostic equipment used, can get sigientes results.

* Case cardiac disorders in heart rhythm (arrhythmia), acute coronary syndrome (myocardial infarction or angina), problems with heart valves or pulmonary embolism.

* Case no heart: Elevation or sudden decrease in blood pressure vasovagal syncope, seizures, transient cerebral ischemia, hypotension or migraine.

* Unknown Cause: approximately 14% of cases is not possible to detect the origin of the fainting with this test.

* Negative result, the patient does not suffer from any vascular dysfunction that causes your symptoms.

The test is considered positive if the person completed faints or goes to the brink of collapse. When this test is positive, treatment should be a cardiologist for pre-medication to help control the problem