Head-up tilt test, also known as HUTT, is the non-invasive test. This is the test where neurologist and cardiologist both come together done to find out the cause of unexplained fainting episodes. We call this episode as syncope.
What is Head-up tilt test
Cardiologist and Neurologist often see patients presenting with a history of unexplained fainting episodes. Certain situations or the triggers precipitates this fainting episode. Many times, even after detailed cardiac and neurology examination and basic tests, the diagnosis of these syncope episodes are not clear.
In this scenario, HUTT is very useful in establishing the diagnosis of vasovagal syncope. This is not a confirmatory test. But, it helps your doctor to narrow down the differential diagnosis.
When we advice Head-up tilt test
- If any patient gives a history of fainting episodes in specific environment/situation/position. e.g. fainting on seeing blood, fainting when feeling severe pain.
- fainting episodes while getting up from the bed- Postural relation
- Prolonged standing causing fainting episodes
- fasting and dehydration combined with prolonged standing triggering a fall
- Fall preceded by warning symptoms with yawning
- syncope episodes spread over many months or years.
How to prepare
- We advise the patient to have light breakfast with an empty stomach of 2 to 3 hours
- The patient can take water as and when required. This is not a test requiring absolute fasting.
- Wear loose articles of clothing. Try to relax, get the feel of the surroundings.
- Continue your prescribed medicines, Your doctor usually will scan the prescription and stop some medicines which can interfere with the test results.
- Bring some water/juice to hydrate yourself after the completion of the test.
- One of the responsible relatives needs to accompany you.
What happens during a tilt-table test?
You’ll lie down on a special table, and a medical professional will attach various monitors to your body. These include a blood pressure cuff, electrocardiogram (ECG) leads, and an oxygen saturation probe. Someone might also start an intravenous (IV) line in your arm so you can receive medications if needed.
A nurse will tilt or move the table up and elevate your head about 45 degrees above the rest of your body. The nurse will check your vital signs at every 2 to 3 minutes.
A nurse will continue to tilt the table upward about 70 degrees or more, essentially making you upright. They’ll repeatedly measure your blood pressure, heart rate, and oxygen levels to detect if there are any changes.
The different centre may have different protocols of giving drugs during test and degrees of elevation.
If Nurse notices any fall in blood pressure or heart rate or notices your symptoms, she will lower down the table immediately. You will be relieved of your symptoms and you need not worry.
If you don’t have a change in your vital signs and no symptoms of giddiness, the next phase will start. In this phase, an injection is started through the IV line, or nasal spray is given. With these medicines, your heart rate will increase and you will start feeling mild symptoms in your body as if you are doing certain strenuous work. Your defence mechanism will prevent loss of consciousness and subsequent fall. If the body gives up this control, your blood pressure and/or heart rate will fall suddenly and you will start losing your consciousness. Immediately, the nurse will stop the injection infusion and lower the tilt table, and you will recover promptly. Believe us, its complete recovery and you need not worry at all.
The test will typically last about an hour and a half if you don’t have changes in your vital signs. If your vital signs do change or you don’t feel well during the test, a nurse will stop the test.
After the test :
You will be asked to stay in a normal bed for a half-hour for observation and complete recovery. You should take some liquids and light snacks during this time.
An IV line and electrodes will be removed and then you will be relieved from the daycare facility. You can resume your daily routine immediately. Some patient does feel tired or nauseated, however.
A negative result means you didn’t have any symptoms during the standing phase as well as the drug phase. Chances of having vasovagal syncope as a cause of your fainting are less likely
This test result requires a lot of clinical correlation with your history, physical examination findings and other investigation. Your Cardiologist and Neurologist will explain to you the result and its implications.
Feel free to communicate if any doubts on this test or related to your history of recurrent fall.