Key result
Head-up tilt testing evaluates autonomic responses to orthostatic stress to detect syncope, orthostatic hypotension, and POTS.
The head-up tilt test is a valuable diagnostic tool for evaluating orthostatic syndromes and dysautonomia, with its diagnostic yield expanded by adding capnography and cerebral blood flow monitoring.
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Supports adjunctive monitoring in tilt testing for dysautonomia; leaves open prospective validation of yield gains.
SUMMARY: This review recapitulates the head-up tilt test, which is commonly used for evaluation of orthostatic syndromes and dysautonomia. Tilt test evaluates autonomic system responses to orthostatic stress. Established tilt testing includes monitoring of heart rate and blood pressure; adding capnography and cerebral blood flow monitoring expands its diagnostic yield and allows assessing cerebral blood flow regulation. Common syndromes detectable by the tilt test are neurally mediated syncope (vasodepressor, cardiovagal, or mixed), orthostatic hypotension, postural orthostatic tachycardia syndrome, hypocapnic cerebral hypoperfusion, and orthostatic cerebral hypoperfusion syndrome. This review describes relevant physiology, tilt test protocols, diagnostic criteria for orthostatic syndromes, grading test results, diagnostic accuracy, limitations of the tilt test, and safety considerations.
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Becerra et al. (2021) conducted a review in Orthostatic syndromes and dysautonomia. Head-up tilt test was evaluated. The head-up tilt test evaluates autonomic responses to orthostatic stress to detect syndromes like neurally mediated syncope, orthostatic hypotension, and postural orthostatic tachycardia syndrome.
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