Tilt table examination

The tilt table examination (also known as the tilt test) is an examination procedure in human medicine . It enables the assessment of the adaptation of the blood pressure to passive changes in position of the patient and can explain orthostatic hypotension (failure of the blood pressure to adapt to rapid changes in position) or vasovagal syncope (fainting after a long period in an upright position) as the cause of repeated sudden unconsciousness ( syncope ) help. Cause orthostatic dysregulation may have a faulty control of the heart , the blood vessels or a loss of function of the autonomic nervous system be.

indication

Syncope is a common occurrence in the general population. In older people, the incidence is 6% per year, 1/3 of whom suffer from multiple syncope in a row. The dangers and consequences of severe injuries resulting from this are evident.

Comprehensive diagnostics enable the cause of syncope to be clarified in up to 70% of cases. For some causes, measures against relapse can have a positive effect on morbidity and mortality . A tilt table examination is usually carried out if the previous examinations such as echocardiography , ergometry , long-term blood pressure measurement , long-term ECG and simple circulatory tests have not produced any conclusive results.

The tilt table examination can provide clues for the classification of syncope without necessarily triggering it.

execution

The principle of the tilt table examination is based on understanding the pathomechanisms that led to the experienced syncope under controlled conditions. The patient, who is secured on a special examination table, is slowly “tilted up” from lying horizontally to 60–70 °, causing the blood to “sink” into the lower extremities ( venous pooling ). This means that less blood is available to the heart, the stroke volume decreases and blood pressure drops. In order to be able to assess the compensation mechanisms triggered by this, blood pressure and heart rate are determined regularly during the experiment . Based on this, a distinction can be made between normal and pathological circulatory reactions and, in some patients, specific treatment of possible circulatory reaction weaknesses can be made possible. If “tipping over” is not enough to trigger circulatory stress, a pharmacological provocation with nitroglycerine can also be carried out (“Italian protocol”).

In healthy test persons, after “tipping over”, there is a short-term drop in blood pressure which, via the activation of baroreceptors, leads to constriction of the vessels and an increase in heart rate. If this reaction is disturbed, the drop in blood pressure is not sufficiently compensated and the patient becomes unconscious (positive test result). Secondary dysregulation or neurocardiogenic dysregulation is when the compensation mechanism was initially successful, but there is a delay in a drop in blood pressure. A further distinction is made here between a cardioinhibitory type, in which blood pressure and heart rate drop, and a vasodepressor type, in which the heart rate remains unaffected.

There can be several reasons for a positive test result. In order to be able to understand whether a drop in blood pressure or heart rate has led to unconsciousness, the blood pressure is measured continuously during the experiment in more modern implementation procedures. If this data is logged, the test can be terminated as positive during the presyncope. In this way, syncope and associated potential complications are avoided.

Complications

Overall, the tilt table examination is very safe. There are no reports of deaths from the investigation. The occurrence of syncope is considered a positive test result and not a complication. Depending on the type of dysregulation, this can lead to a sharp drop in heart rate up to self-limiting asystole . In rare cases, pharmacological provocation can lead to further side effects.

literature

M. Brignole: European Heart Journal . 2001.
Martin H. Hust, Karl F. Heck, Matthias W. Keim: Tilting table test for the diagnosis of vasovagal syncope . In: Deutsches Ärzteblatt . tape 96 , no. 22 , 1999, p. A-1488–1492 ( cardio-med.de [PDF; 109 kB ]).
A. Ungar: Journal of the American Geriatric Society . 2006.

Individual evidence

↑ ^a ^b F. Er, E. Erdmann: The tilt table investigation . In: German Medical Weekly . tape 134 , 2009, p. 1535-1538 .
↑ Kreiskliniken Reutlingen GmbH: Patient information on neurocardiogenic syncope and the tilt table test
^ The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC): Guidelines for the diagnosis and management of syncope (version 2009) . In: European Heart Journal . tape 30 , 2009, p. 2631–2671 , doi : 10.1093 / eurheartj / ehp298 .
↑ Thomas Weber: Importance of the tilt table examination in the diagnosis of syncope . In: Journal of Cardiology . tape 10 , no. 11 . Krausse & Pachernegg, Gablitz 2003, p. 473–480 ( kup.at [PDF; accessed November 25, 2015]).

[Erdmann2009-1] F. Er, E. Erdmann: The tilt table investigation . In: German Medical Weekly . tape 134 , 2009, p. 1535-1538 .

[2] Kreiskliniken Reutlingen GmbH: Patient information on neurocardiogenic syncope and the tilt table test

[3] The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC): Guidelines for the diagnosis and management of syncope (version 2009) . In: European Heart Journal . tape 30 , 2009, p. 2631–2671 , doi : 10.1093 / eurheartj / ehp298 .

[4] Thomas Weber: Importance of the tilt table examination in the diagnosis of syncope . In: Journal of Cardiology . tape 10 , no. 11 . Krausse & Pachernegg, Gablitz 2003, p. 473–480 ( kup.at [PDF; accessed November 25, 2015]).