From the Guidelines
Patients with abnormal tilt table test results are best managed by cardiologists, particularly those specializing in electrophysiology or autonomic disorders, as they are primarily responsible for evaluating and treating conditions like vasovagal syncope, orthostatic hypotension, and postural orthostatic tachycardia syndrome (POTS) that are often indicated by abnormal tilt table test results 1.
Key Considerations
- The tilt table test is used to assess the body's regulation of blood pressure and heart rate in response to positional changes, and abnormal results often require specialized care from cardiologists with expertise in autonomic disorders or electrophysiology 1.
- Neurologists with expertise in autonomic dysfunction may also be involved in the management of patients with abnormal tilt table test results, particularly when there are concerns about convulsive syncope or pseudosyncope that may mimic epilepsy or other neurological conditions 1.
- The treatment approach for patients with abnormal tilt table test results varies based on the specific diagnosis but may include lifestyle modifications, increased fluid and salt intake, compression stockings, and medications like fludrocortisone, midodrine, or beta-blockers 1.
Specialist Involvement
- Cardiologists specializing in electrophysiology or autonomic disorders are crucial for developing individualized treatment plans that address the underlying autonomic nervous system dysfunction causing the abnormal cardiovascular responses detected during the tilt table test 1.
- In complex cases, patients may require referral to a specialized autonomic disorders clinic for comprehensive management, highlighting the need for a multidisciplinary approach to care 1.
Evidence-Based Practice
- The 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope provides recommendations for the use of tilt-table testing in diagnosing and managing conditions like vasovagal syncope, orthostatic hypotension, and pseudosyncope, emphasizing the importance of evidence-based practice in the management of patients with abnormal tilt table test results 1.
From the Research
Specialist for Abnormal Tilt Table Test
The specialist who deals with patients with abnormal tilt table test results can be identified based on the conditions that the test is used to diagnose.
- The test is used to diagnose disorders that may cause transient loss of consciousness (TLOC), such as reflex syncope, orthostatic hypotension (OH), postural orthostatic tachycardia syndrome, and psychogenic pseudosyncope 2, 3, 4.
- The test is also used to assess orthostatic hypotension (OH), chronic orthostatic intolerance (COI), and unexplained syncope 5.
- Based on these conditions, the specialist who deals with patients with abnormal tilt table test results can be a cardiologist, neurologist, or an autonomic nervous system specialist 6.
Conditions Diagnosed with Tilt Table Test
The tilt table test is used to diagnose a range of conditions, including:
- Reflex syncope
- Orthostatic hypotension (OH)
- Postural orthostatic tachycardia syndrome
- Psychogenic pseudosyncope
- Chronic orthostatic intolerance (COI)
- Unexplained syncope
Specialist's Role
The specialist's role in dealing with patients with abnormal tilt table test results includes:
- Interpreting the test results in the context of the patient's clinical presentation 5
- Diagnosing the underlying condition causing the abnormal test result
- Developing a treatment plan to manage the condition
- Educating patients on how to recognize hypotensive symptoms and perform physical counter maneuvers to prevent syncope 2, 3, 4