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Some people diagosed with epilepsy actually have
Neurally Mediated Syncope
What is a Tilt Test? A Tilt Table Test or TTT is widely used in making
the diagnosis of Neurally (pronounced new-rully) Mediated Syncope (pronounced syn-cup-ee)
or NMS. Both of them are discussed below.
What is Neurally Mediated Sysncope
(NMS) and why do these patients pass out?
NMS is a condition that can occur in a wide range of people, many of
whom do not have any other associated cardiovascular problems. These patients give a
history of repeatedly having syncope (passing out spells) over the course of several
years. Some of these spells may be preceded by a hot sensation or nausea but many come on
without any warning. The patient may fall to the ground and recover consciousness quickly
and without any further problems. The episodes of syncope may occur at church, in the
grocery store, while a blood specimen is being drawn, or while sitting quietly at home,
etc. Surprisingly, the majority of the patients never sustain serious injuries and the
diagnosis may go undetected for decades. Patient's get used to having "faints"
and life goes on! The availability of the Tilt Test, its wide success in establishing the
diagnosis of NMS, and effective treatment for NMS has resulted in the well deserved
popularity of the test.
How safe is a Tilt test?
The test is fairly safe, although it can be dramatic for the patient if the
test is positive and causes a black out (spell). Not a very
pleasant circumstance! However, the patient needs to recognize that this denotes a
positive response and opens the door to the addition of extremely effective medications
that may dramatically reduce or totally eliminate the patient's recurrent black out
spells. In rare cases, the test may produce persistent abnormal heart rhythm and patients
with coronary artery disease may occasionally experience lingering chest discomfort.
Experienced staff and equipment are on hand to handle these potential complications.
What information is provided by
the Tilt test?
The tilt test helps to confirm the diagnosis of NMS. This is extremely important
because there is effective treatment for the condition which can either totally eradicate
or dramatically reduce the frequency and intensity of symptoms (dizziness and black out
spells). Recent research studies have also shown a correlation between chronic fatigue
syndrome (CFS) and NMS. Treatment aimed at NMS has been shown to be beneficial in many
patients with CFS (if they have a positive tilt test). The use of beta-blockers is most
commonly employed in the treatment of NMS. The beta-blockers acts as a
"governor" on a carburetor. The motor does not "rev up" as much (HR
and BP does not increase drastically) and the back seat driver (parasympathetic system)
remains calm and does not slam on the brakes. Other drugs that have shown benefit include
aminophylline, disopyramide and certain anti-depressants serotonin-uptake inhibitors).
Before
the test:
Do not eat or drink anything after midnight the night before the test.
If you take medicines, ask your doctor which ones to take or not to take before the test.
Use only a small sip of water to swallow your pills.
You will wear a hospital gown for the test.
You may wear your own slippers, socks or shoes if you wish.
You will have an IV placed in your arm before the test.
During the test:
1. The test will last 1 to 2 hours.
2.
You will be placed on a special table that lifts you from a lying to a standing position.
You will have safety straps to hold you in place.
3. The room will be quiet and dimly lit.
4. You will be connected to a cardiac
monitor, an EKG machine, and a blood pressure monitor. You will then be lifted from
a lying to a standing position for up to 45 minutes.
6. It is
common to feel your heart beat faster. You may also become a little lightheaded or faint.
Tell your doctor or nurse if you have dizziness, nausea, lightheadedness, hot flashes, or
any other symptoms.
7.After the first
tilt, you may be given medicine through the IV to increase your heart rate.
You will again lie flat for 10 to 15 minutes, and then be returned to the upright position
for up to 45 minutes.
After the test:
You will be allowed to recover
before returning to your room or home.
You will be able to resume your
current diet.
Your
doctor will talk with you and your family about the results of this test.
You may
be started on medicine that will help control the your symptoms.
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