If you child has episodes of fainting, his or her healthcare provider may advise a tilt table test. Syncope can have many different causes. It may occur rarely or often. Causes of syncope related to the heart may include:
- Vasovagal syndrome (or neurocardiogenic syncope). A sudden drop in blood pressure with or without a decrease in heart rate. It is caused by a problem of the nerves controlling the heart and blood vessels. This is the most common cause of syncope and can follow periods of extreme emotion.
- Arrhythmia. A heart rate that is too slow, too fast, or too irregular to keep enough blood flow to the body, including the brain. This is a rare, but potentially dangerous cause of syncope.
- Structural heart disease (muscle or valve defects). There may be problems with the heart muscle or one or more of the heart valves. This may cause a decrease of blood flow to the body, including the brain. Inflammation of the heart muscle known as myocarditis may also cause fainting. The heart muscle becomes weak and is not able to pump as well as normal. The body again reacts to decreased blood flow to the brain by fainting.
- Orthostatic hypotension. This is a drop in blood pressure that occurs when a person has been standing for a while, or changes from a sitting to a standing position. Blood pools in the legs, preventing a normal amount of blood from being pumped to the brain. This brief drop in blood flow to the brain causes a person to faint. This is more common in senior adults.
Other problems that can cause syncope include:
- Head injury
- Inner ear problems
- Low blood sugar
- Breath holding episodes
- Brain mass
- Aneurysm or abnormality of a blood vessel in the brain
- Urination or having a bowel movement
When a healthcare provider sees a child with fainting episodes, he or she will carefully check the child's medical history and do a physical exam. Tests include an electrocardiogram (ECG) and often an echocardiogram (ultrasound exam of the heart). If the exam or history do not reveal a cause for the fainting, and the child has no history of a heart condition, then further tests, such as a tilt table procedure, may be done.The only risk for your child during a tilt table test is fainting. If fainting does occur, your child is in a safe, supervised setting and will not be hurt.Your child should not eat or drink for 4 hours before the tilt table test.
A tilt table procedure may be done in a special clinic or in the hospital. It may take from 30 to 90 minutes. The test will be as follows:
- Your child will lie on a special table or bed. Straps will be placed across his or her chest and knees to help him or her stay in the correct position.
- A healthcare provider will put an IV needle in one of your child's arm veins to give medicine.
- The provider will put a blood pressure cuff on one of your child's arms to check blood pressure throughout the test.
- The provider will attach electrodes with wires to your child. The wires are attached to a device (electrocardiogram). This will let the provider monitor your child's heart rhythm throughout the test.
- The provider will tilt the table so that your child's head is higher than his or her body. Your child will stay in that position for a while. The provider will watch for changes in your child's blood pressure and heart rhythm. The provider will also watch your child for dizziness, fainting, and other symptoms.
- The provider will raise tilt the table higher and again watching for changes in your child's blood pressure and heart rhythm.
- If your child's blood pressure drops, the provider will end the test and report the results to your child's healthcare provider.
- If there are no changes in blood pressure, the provider will give your child medicine through the IV line. The medicine will cause your child's heart to beat faster and harder. This makes your child more sensitive to the changing positions. It is similar to what happens when your child exercises.
- The provider will tilt the table so that your child's head is raised. He or she will watch for changes in your child's blood pressure and heart rhythm.
- The provider will stop the test if your child's blood pressure drops. If it does not drop, the provider will end the test after watching your child's blood pressure and heart rhythm for a while.
Your child may feel tired and nauseated for a while after the test. He or she will be watched for about 30 to 60 minutes. You healthcare provider may give you specific instructions. Test results are available in a few days.
The test may not cause any symptoms, or changes in your child's ECG or blood pressure. If so, your child may need more tests or procedures to find the cause of the syncope.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
January 16, 2018
Swizza, M., Head up Tilt Table Testing in Syncope: Safety and Efficiency of Isosorbide versis Isoproterenol in Pediatric Population, American Hear7-482t Journal (2008); 156(3);47, Reflex syncope, Up To Date, Batra, A., Usefullness of Tilt Table Testing in Children with Syncope, Indian Pacing and Electrophysiologic Journal (2008); 8(4);242-246
Gandelman, Glenn, MD, MPH,Bass, Pat F., III, MD, MPH