Tilt Testing

General Information

This test is performed to investigate causes of recurrent blackouts (or syncope) suspected to be due to the cardiovascular system. It will involve continuous ECG and blood pressure monitoring. During the test a head-up tilt is performed to observe the effects on heart rate and blood pressure. It takes around 40mins. It is advisable to avoid a heavy meal prior to and wear comfortable clothes for this test.

What is syncope?

Syncope is temporary loss of consciousness and postural tone, described as "fainting" or "passing out." It most often occurs when the blood pressure is too low and the brain does not get the required oxygen supply.

What causes syncope?

There are many known causes of syncope including:

  • Sudden changes in body position or prolonged standing
  • Overheating
  • Dehydration
  • Emotional stress
  • Side effects of some medications
  • Heart rhythm disorders or other cardio-pulmonary diseases
  • Neurological disorders (e.g. seizure/stroke)
  • Neurally mediated syncope


What is neurally mediated syncope?

Neurally mediated syncope (NMS) encompasses neurocardiogenic, vasovagal, vasodepressor or reflex mediated syncope. Although it is the most frequent cause of fainting, it is usually benign. NMS is more common in children and young adults with no evidence of structural heart disease, although it can occur at any age. Typical NMS is often preceded by a sensation of warmth, nausea, lightheadedness and visual blurring. During an episode, lying down in the supine position will help to restore blood flow and consciousness.

How is NMS treated?

To help prevent syncope, people with NMS should be on a high-salt diet and drink plenty of fluids to avoid dehydration and maintain blood volume. They should watch for the warning signs of fainting - dizziness, nausea and sweaty palms - and sit or lie down if they feel the warning signs. Some people may also need medication.

  • Professor Sanders says...

    Atrial fibrillation is a consequence of several reversible risk factors - high blood pressure, diabetes, obesity, sleep apnoea, and excessive alcohol. Your management of atrial fibrillation must include strict control of these risk factors.