TILT TABLE TEST

[JAMI__0__0]

  I am an 18 year old female who has recently been diagnosed with some form
  of tachycardia.I have recently been on a event monitor for 35 days to determine
  the exact type.  The monitor showed PAC's and PVC's.  My cardiologist says
  that he won't treat the PAC's, and is hesitant about treating the PVC's,
  but what he worried about is 3 fainting episodes that have occured
  throughout a time period of 4 months. 2 were in the shower and 1 while I
  was driving.  My Doctor says that this could be a sign of Syncope and
  wants to have a Tile Table Test done next Wednesday to see if the cause
  of my fainting is due to my heart palpitations that take place about 3
  times a week for 30 minutes at a time.  I was on Beta-blockers, Atenolol
  and Inderal, and my body could not handle the medication.
  Here are my questions:
  Can you explain syncope?
  Can you explain the Tilt Table Test?
  As I have been getting the beta blockers completely out of my system, the
  episodes have become more and more frequent.  I suspect that they will
  be happening everyday as soon as the medication is completely out. During
  these episodes I get hard palpitations, lightheaded, and dizzy.  They are
  very annoying.  I have spoken to my cardiologist about Ablation being a
  possibility. I am 18 years old now, I cannot imagine this happening for the
  rest of my life.
  Even if these syncope spells are not due to cardiac reasons
  should I consider the Ablation proccess to get my life back on track?
  I am very nervous and scared right now.  Especially for the Tilt Table Test.
  Your opinion and any information would be greatly appreciated.    
  Thank you for your time
  Jamie

[Cleveland Clinic, MD]

_

Dear Jamie,
The medical term for what you are describing is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  The most common cause is the common faint (neurocardiogenic or vasovagal syncope).  This is the typical faint caused by strong emotional factors (i.e. the sight of blood) and is usually brief in duration.  The person almost never harms themselves and the precipitating factor can usually be identified.  More serious forms of syncope are due to cardiac and neurologic causes.  
Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.
Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.  Tilt table testing is a simple test that is pretty much what it sounds like.  The patient is placed on a table and ECG and blood pressure monitoring are attached.  The table is then tilted upright so the person is in a vertical position and the heart rate and blood pressure are monitored.  People with certain types of syncope are more likely to have symptoms during this test.  The entire test lasts about a half hour.
As you can see the diagnosis is somewhat complex. Therefore, I would recommend that you see a specialist in the area of syncope.  Two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.