1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
Never Ask Us if We're Hungry -- The Answer's Always No
There are three of us here and for many years, none of us ever got hungry. When our brains would turn to mush, when our faces would go numb, and we would start the invisible vibration which is the signature dance of ME/CFS, we knew we needed to eat.
Discuss the article on the Forums.

Tilt Table Test - which degree angle?

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by Blue, Sep 7, 2012.

  1. Blue

    Blue

    Messages:
    27
    Likes:
    37
    Germany
    Hi,

    I am currently trying to get referred to an autonomic specialist which is not easy here in Germany. Yesterday I made my own test at home - first lying down and measuring blood pressure und heart rate and than standig up for 10 minutes and measuring again. Heart rate went from 87 to 138, blood pressure was strange - one value increased, other decreased...

    Well, I really like to get that checked but I am wondering about that Tilt Table Test: Because I have read that it is carried out with a degree angle of 60 to 80 degree - and I don't really understand this - will this produce the same symptoms than standing in 90 degree at all? And additionally - at the tilt table you can lean on the table which you don't when standig normally - so won't these factors alter the findings you usually have in everyday life?

    Perhaps someone here from the POTS-experienced people could help me with that question?:)

    Thank you very much!

    Best Blue
    taniaaust1 likes this.
  2. Sushi

    Sushi Moderator and Senior Member Albuquerque

    Messages:
    6,878
    Likes:
    5,718
    Albuquerque
    Hi Blue,

    I have had a tilt table test. It would be interesting to know the changes in both your systolic and diastolic blood pressures--you said one went up and one went down? After about 30 minutes, my systolic had dropped a lot and my diastolic had gone up a lot--this is not necessarily typical, but was very abnormal.

    The difference between the 2 is called the pulse pressure and is significant in diagnosing autonomic dysfunction. The BP readings and the actual pulse will be monitored in the TTT as well as a continuous electrocardiogram and sometimes other things.

    I don't know why they usually use about an 80 degree tilt, but maybe someone else does. I will say that the TTT can be very hard on the body and is usually pretty unpleasant, though, if done well, can give good information about the autonomic nervous system. It often requires some days afterward for recovery.

    Here is one article about it, though it doesn't talk about some of the important mini-tests that are often done during the TTT. http://www.hrsonline.org/patientinfo/symptomsdiagnosis/hearttests/tilttabletest/

    When you try testing at home, be sure that you have your arm resting on something that is at the same level as your heart.

    Best wishes,
    Sushi
    Blue likes this.
  3. Blue

    Blue

    Messages:
    27
    Likes:
    37
    Germany
    Hi Sushi,

    thank you very much for your reply! Last time when I did measure at home, the systolic after 10 minutes had gone up to over 150 and the diastolic had dropped to something like 55. Another time when I did the test, the diastolic even went to 40. But I didn't have the arm resting on my heart level, but my blood pressure monitor is one that is fixed a the upper arm - so I assume it's at the right position?

    What diagnosis did you get with your abnormal blood pressure values during the TTT?

    Thank you for the article as well! Did you faint during the test? Because I have never fainted during my tests at home. And if the test is only positive when someone faint during the TTT (as the article says), I guess I will be negative...

    Well somehoe I have to get that TTT done I guess...

    Thank you again and many regards,
    Blue
  4. taniaaust1

    taniaaust1 Senior Member

    Messages:
    7,944
    Likes:
    4,920
    Sth Australia
    A raise in heart rate as long as the BP is being taken correctly, of 30 beats per minute or above from laying to standing .. IS dysautonomia aka also a Postural orthostatic tachycardia syndrome (POTS) diagnoses.

    Your "heart rate" probably will be similar if it is taken with the arm raised out with the hand lightly resting on something or down (its the heart which is important when it comes to POTS not the BP).. thou possibly raising it to heart level, as raised arms sometimes trigger off POTS, could make the heart rate go up even higher then it didl

    A 30 beat increase or more, isnt normal at all on a tilt table OR poor mans test and gives one a diagnoses. (So this is enough to be starting some POTS treatment which may also help other autonomic disorders too which you probably also do have). Usually things like increasing fluids, salt and graded medical support stockings are tried and then meds added if needed (which i think you probably willl end up needing as that is quite an increase you have there)..

    All depends on HOW MUCH your BP is raising or falling from laying to being standing whether you have an issue there or not (some change to a certain point is normal). Depending on what it's doing (you need to give us more info for someone to tell you) you could have "orthostatic" systolic hypertension (if the systolic is going up an abnormal amount) or NMH (orthostatic hypotension). When taking BP the cuff should be always level with your heart.

    Only about 30% of POTS patients ever faint....so fainting isnt a necessary diagnostic criteria.. its what your heart is doing which is. (different articles thou often say slightly different things as there is no set standard except of the heart increase of 30 beats). Even with the tilt table testing, different hospitals do them different ways.. some places even give the patient something which makes their autonomic system even more senstive to the test.

    I think why they do it on the on 80 degree angle may be due to if one was upright completely and was feeling faint or very weak.. they'd have to have straps having to fully support the weight of the person and the pressure of those could affect the reading (this is just a guess).
    Blue likes this.
  5. taniaaust1

    taniaaust1 Senior Member

    Messages:
    7,944
    Likes:
    4,920
    Sth Australia
    Think of it this way.. when a person gets tilt table tested even thou they dont have the same angle as doing a poor mans test, the person is being raised on table without having to get up and move. This not moving makes them more sensitive to the test (where as you've had to get up.. which can stop some POTS patients from getting a result from a poor mans test). You have POTS and do not need a tilt table test to be diagnosing that. (a POTS med such as Florinef could well help any other dysautonomia conditions you have with the POTS be it orthostatic hypotension or orthostatic hypertension (via helping blood volume..low blood volume can cause all these), so at this stage you may consider if you are going to still need a tilt table test to look for coexisting other dysautonomia things or just try to treat the POTS which could help the other issues you may have anyway.
    http://www.dinet.org/pots_an_overview.htm

    best luck
    ps consider getting medical support stockings (be aware those are available on some health insurances so if you have this.. ring your company to find out the criteria for getting them partly funded back).
    ps make sure they are ones suitable for orthostatic issues eg medical compression ones.. of the right kind of pressure for these issues.
    Blue likes this.
  6. ahimsa

    ahimsa Senior Member

    Messages:
    1,046
    Likes:
    904
    Oregon, USA
    Hi Blue,

    My understanding of the Tilt Table Test is that a patient on a table tilted to 80 degrees is actually more likely to have symptoms than when standing. As posted above, any amount of moving around, and the action of the leg muscles being used to stand, may cause the patient to have fewer symptoms when standing vs. when tilted.

    I see that taniaaust1 already posted a link to the dinet.org web site but here are some more links in case they are helpful:

    Brief overview of Orthostatic Intolerance (POTS and NMH) in ME/CFS patients:
    http://www.cfids.org/about-cfids/orthostatic-intolerance.asp

    Video by Dr. Peter Rowe of Johns Hopkins:


    Slides (PDF file) that go with the video above:
    http://www.cfids.org/webinar/slides-090110.pdf

    The exact procedure used for the Tilt Table Test differs from clinic to clinic. And you may not need one if your diagnosis is POTS and you don't think you have some other type of autonomic dysfunction.

    By the way, anyone suspecting NMH (aka, neurocardiogenic syncope and other names) should ask for the first phase of the tilt table test to be at least 40-45 minutes long. The extreme drop in blood pressure may take that long to show up. For example, I have NMH and while I got symptoms within 5 minutes or so it was 20-30 minutes before the sudden plummet in BP happened.

    In case you want to read more about the test here's one description from the Mayo Clinic:
    http://www.mayoclinic.com/health/tilt-table-test/MY01091/DSECTION=what-you-can-expect

    I hope this helps! :)
    Blue likes this.
  7. Sushi

    Sushi Moderator and Senior Member Albuquerque

    Messages:
    6,878
    Likes:
    5,718
    Albuquerque
    Hi Blue,

    Just saw your post. If you quote from a person's post, they will get a message and be aware that there was a reply. My autonomic specialist thought it was important for the upper arm (where the BP cuff is) to be at heart level.

    My diagnosis was autonomic dysfunction--closer to NMH than anything else. There were 3 positive diagnostic markers.

    No, I didn't faint and the doc told me to stop the test if I felt like I was going to faint. He has POTS himself and knows how awful it is to faint. He said he could get enough information from pre-syncope. But I am not a fainter anyway--just pre-syncope. There are lots of other diagnostic criteria that give a positive diagnosis, so don't worry if you are a "fainter." Be glad!

    Best wishes,
    Sushi
    Blue likes this.
  8. Blue

    Blue

    Messages:
    27
    Likes:
    37
    Germany
    Hi Tania, Ashima and Sushi,

    thank you very much for your great replys - this is really good info! I've just watched the webinar with Dr. Rowe - really interesting.



    I didn't know about those details - thanks a lot! I guess I am then in the group of systolic hypertension as the systolic after 10 min went to over 150. But I'd like a specialist to speak out a verdict ;-) Because I don't dare to just take the Florinef or something else, I'd like to have a doctor who can supervise me a little bit. As support stockings - many thanks for this advice at well - I going to pick mine from the pharmacy tomorrow! I am already excited. But they are only up to the knees. Well I will see what they do! Do you wear them regularly? And do you have stockings to the waist?

    That makes sense! Well propably I should have a little trust that the doctors know what they are doing, but with a ME/CFS career that's often not so easy ;-)

    I hope I did the quoting her and above correclty? Never quoted before on this forum... Well, thank you for explaining the fainting. Yes, I am glad I don't faint! It's good to know that one can get a diagnosis and a therapy without that special symptom.

    I am still trying to organise my visit at a specialised clinic, so hopefully sometime I will know more what is behind my OI!:)

    Thank you all again and a nice rest weekend!
    Blue
  9. Calathea

    Calathea Darkness therapy

    Messages:
    1,086
    Likes:
    537
    Scotland
    If you are prone to these problems, you will have developed unconscious strategies to stop from keeling over when you stand up. These will include swaying, general wriggling about, and tensing the muscles of your legs or buttocks. Most people haven't a clue that they're doing this, but if they stopped, they might end up falling very quickly. Putting you at a slight angle for the TTT means that you are far less likely to employ these measures, as far as I am aware, as you no longer need to keep yourself upright, the table is doing that for you.

    I've only been doing the home versions so far. Someone advised me to stand in a corner, which helps as it does a fairly good job of supporting me and makes me less likely to wriggle around. Note for anyone trying this at home: make sure there is some means of summoning help if you fall, and don't stand somewhere where you'd be blocking access to rescuers (e.g. the corner of my bedroom door is an exceedingly stupid place to stand, as they wouldn't be able to open it to get to me if I fell). I've been getting various readings. My BP goes crazy and usually includes a narrow pulse pressure such as 15. My HR sometimes goes up fairly rapidly, but at other times it takes about 15 min before I am over the 30bpm increase. I don't know how much of this could be due to the fact that a home blood pressure monitor is a fairly crappy thing to use for this sort of test, particularly for heart rate, where you apparently need beat-to-beat fingertip testing. Also most of my tests have been sitting-to-standing, as lying-while-well-rested-to-standing tends to be hard to set up. Any thoughts?
    Blue, taniaaust1 and ahimsa like this.
  10. Sushi

    Sushi Moderator and Senior Member Albuquerque

    Messages:
    6,878
    Likes:
    5,718
    Albuquerque
    Thanks for the quoting, Blue. Are you getting an "alert" that you have been quoted when we reply to you? I think you have to include the very beginning with the person's name in brackets for the alert to work. (at least I didn't get one when you quoted me now)

    You can do this by clicking on "reply" in the lower right hand corner of the person's post. Then their whole post will show and you can delete any part that isn't relevant to your reply. Just be sure to leave in the brackets at the beginning and the end. There are probably other ways to do this, but this is the one I know!

    I wanted to comment that stockings from the pharmacy may not be good enough and they will probably be WHITE! You need graded compression ones. There are many online sites that sell them as well as medical supply houses. Often you will be individually measured and may be covered by insurance.

    I don't know where to look in Germany, but to give you an idea of what to look for, go to this site: http://www.brightlifedirect.com/ They show just about all the choices. I use graded compression cotton knee socks but many prefer thigh-high or full panty hose. They come in different compression levels, different colors, open or closed toe, etc. The panty hose are a real work-out to get on though!

    Most people don't wear them when lying down, but some do. Depends on what your BP does.

    I think it is a good idea to have a doctor supervise meds like Florinef or any others for dysautonomia. For instance, while Florinef is great for many, it is not for others--me included--I couldn't tolerate it.

    Best wishes,
    Sushi
    Blue and ahimsa like this.
  11. I believe the initial protocol for tilt table testing said 70 degrees. This will actually make you feel like you are leaning forward. If you are leaning back at all it will not work.

    It is really important that you get a table that is calibrated.
    When I took the test they did not put me on a calibrated table and just "eyeballed" it. I had read many accounts of people who had this test so I was suspicious when I did not feel like I was leaning forward and in fact felt like I was leaning back. I often lean against things to keep from passing out when out and about.
    My suspicions grew when I didn't pass out right away. My NMH (POTS) is very severe.
    I asked if the table was calibrated and they finally admitted it was not and they were guessing at the correct angle. Great.
    I demanded better. The nurse said she was sure my table was right and put a calibrated table outside my room in the window and tilted it to the correct angle. It was obviously very different than my angle.
    They matched my table's angle to that of the calibrated table at 70 degrees. I finally felt like I was totally upright and a bit leaning forward. I passed out within 5 minutes.

    When I went in for testing I got the protocol for the test and kept it on my belly the whole time (except when they finally put the table up). It was great to have. I wish I had of gone over it in length with the cardiologist ahead of time. I asked him if he was familiar with it ahead of time, but I should not believed him, but just gone over it with him instead.

    I no longer have this protocol since my computer was stolen when my apartment was broken into. Perhaps someone can post the correct one to do with CFS. If I find it I'll post it later.
    Blue likes this.
  12. taniaaust1

    taniaaust1 Senior Member

    Messages:
    7,944
    Likes:
    4,920
    Sth Australia
    I second what another said about the importance of them being medical compression stockings (graded compression stockings are ones which have various pressures in them so you will see them labeled something like compression 20-30 mmHg or compression 30-40.. different grades in them to help push the blood back up the legs). (ones that are only support stockings may not be suitable so do check to see what they say they are suitable for).

    It is possible they could have them in some pharmacies (I think Ive seen them in some in the city). Thigh high or full stockings are usually best for those with these conditions (thou some do do the socks and find them helpful). You'll need at a pressure of at least 20-30mmHg for orthostatic issues (and if that helps any and you dont mind that pressure.. then try higher).

    *be aware that depending on the shape of your legs, you may need to get the glue to hold them up if you ever get thigh highs. (some are fine without the glue..but the shape of my legs dont allow them to stay up without glue).

    Ive avoided getting full stockings as I figure that would be very annoying and awkward if Im going to the loo a lot. I myself prefer open toed ones (I like having my toes free).

    My specialist had me for go a fitting for my very first pair of compression stockings at a medical supply place (thou there is good info online for different brands on how to get the right fits). http://www.compressionstockings.com...ckings-with-silicone-border-unisex-p-246.html (may be the ones I have but Sigvaris calls them "cottons" thou they arent cotton, in my country). That website is a great one has it has all the best brands of compression stockings on it.

    best luck.. I hope you find the ones you've ordered useful :)
    Blue likes this.
  13. taniaaust1

    taniaaust1 Senior Member

    Messages:
    7,944
    Likes:
    4,920
    Sth Australia
    Systolic raising over 20 while standing from a laying BP reading... is orthostatic systolic hypertension. (If you had say a laying sytolic BP of say 135 anyway and it just like rasied 15 and got to 150 systolic.. it wouldnt be really "orthostatic" hypertension in the classical sense). When looking at that issue one is looking at an abnormal raise compared to what it is laying. (many people with ME have issues with the dystolic.. i dont know which is more common.. orthostatic systolic hypertension or orthostatic dystolic hypertension..). http://en.wikipedia.org/wiki/Orthostatic_hypertension
    This should be treated as it can lead to congestive heart failure if its not treated and also carries a higher risk of strokes.

    Other then the info found in the references mentioned on wiki.. there is very little else known about this condition.. its far less studied then even ME/CFS!! (appearing at only the rate of 1% of the normal population, its far less common then ME/CFS but it seems to be not at all uncommon among our ME/CFS communities). The research community should do a study on this and ME/CFS to find out the prevalence in us esp since the condition carries increased risks..

    If you have both POTS and orthostatic hypertension as well as part of your dysautonomia... it makes your case a bit more complex then someone who has only POTS but some things can work for both things. eg medical support compression stockings can possibly help both these things as othostatic hypertension can be connected to low blood volume too, but you may also need an nor adrenaline lowering med for orthostatic hypertension.. on top of something like Florinef to boost blood volume. I suggest to get your standing or 24hr nor adrenaline/adrenaline levels tested (that's a urine test) to see if they are abnormally high.

    **note you cant do meds like this without a doctors support as these meds need careful monitoring and Florinef needs blood monitoring.
    Blue likes this.
  14. Blue

    Blue

    Messages:
    27
    Likes:
    37
    Germany
    Hi Sushi,

    thanks for explaining how to quote correctly, I hope it will work now! And thanks for the advice regarding the support stockings! I had mine measured at the pharmacy. I got a prescription for them from my doctor and so I have to bring this prescription to the pharmacy. I don't know if they are graded - nothing written on the package about that point... But they were made individually for me, so I hope they will fit well! Tomorrow is the big day and I will try to get them on ;-)

    Hi Seattle Sue,

    thanks a lot for that info! I wouldn't even imagine they use tilt tables which don't show the exact angle???? Wow! So many things patients have to be aware of when it comes to testing! Sorry about the lost protocol - but anyway do you get a good treatment now?

    Thanks, Tania! :) I will try them tomorrow and I am glad that the temperature is just going down - I cant imagine wearing these stockings at 30 degrees celsius!

    Wow, you really have a great knowledge about these conditions - thanks a lot for sharing!! Yes, my systolic goes up for more than 20. You are right, I think too, that doctors are even less aware of OI problems than ME/CFS! I have been to a tons of doctors, really, and except one they didn't know or think of this - even the few ME/CFS Docs here in Germany don't really know of this conditions, but at the same time we even have several specialised units in some clinics where you can get testes but aren'r referred usually. Strange situation!

    I am very glad that I have a supportive GP and he helped me to get a referral from a neurologist to that unit - my appointement is already in two weeks! :) I really hope they can help me.

    So thanks again for all your great posts - now I feel well prepared!
    Blue
  15. Sushi

    Sushi Moderator and Senior Member Albuquerque

    Messages:
    6,878
    Likes:
    5,718
    Albuquerque
    You got the quoting right!--thanks.

    I really hope your stockings help. Maybe you can ask them whether they are "graded" when you pick them up. It is just means that the pressure is highest at the bottom and is gradually reduced as you go up the leg.

    Sushi
  16. taniaaust1

    taniaaust1 Senior Member

    Messages:
    7,944
    Likes:
    4,920
    Sth Australia
    It sounds like things are probably on the right track :) Do you know what pressures they are?

    (if they dont help thou.. do check to make sure they were graded compression stockings - the company itself should be certainly able to tell you if the pharmacy doesnt understand the question).

    Did the pharmacy give you a demo on how to put them on? (they arent put on like normal stockings at all and if one does that.. they will be quickly ruined (ive heard of someone completely ruining theirs due to putting theirs on like normal stockings for a couple of months.. Mine are guarenteed to last 6mths with right treatment).

    I dont think there is a set standard for tilt table tests as all places do the test procedure all differently...but yeah there certainly would be some ways out there which are far better then others as far as testing goes.
  17. WXMan

    WXMan

    Messages:
    11
    Likes:
    4
    Cincinnati, Ohio USA
    I've had my POTS Dx'd based on Holter Monitor test and being admitted to the hospital for heart issues (OI issues) and them doing manual "poor man's" orthostatic tests on me by having me lie down, the sitting me up, then having me stand and measuring BP and HR while doing all that. I'm on 3 different meds and my BP is bizarre because it's too high, then it's too low. I have had Hypertension issues for years now and take Lisinopril 10 mg for that and Propranolol ER 160 mg. They have added on Fludrocortisone 0.1 mg now to increase blood volume. One of my doctors is thinking about doing a TTT, however with me taking all my meds, I don't have full POTS criteria every day. I would almost have to go off my meds and then do the TTT for full blown POTS to show up or have the test on one of my "bad days". The doctor thinking about doing the TTT said he's sure it's POTS though based on all my other tests being normal, the symptoms I'm having, and the abnormal Holter Monitor test and issues in the hospital. Standing at a 90 degree angle is what makes my symptoms worse. Still don't understand why doctor is considering TTT if he's "100% sure it's POTS".
    taniaaust1 likes this.
  18. Sushi

    Sushi Moderator and Senior Member Albuquerque

    Messages:
    6,878
    Likes:
    5,718
    Albuquerque
    For a TTT, some doctors would want you take it while on your medications to see how they are working and others (since you don't have a baseline TTT) might want you to stop your meds before the test. I guess it depends on what they are looking for.

    It is a rough test, so I wouldn't want to take it unless it is likely to give some very helpful data.

    Sushi
    WXMan likes this.
  19. WXMan

    WXMan

    Messages:
    11
    Likes:
    4
    Cincinnati, Ohio USA
    Thanks Sushi. That gives me better insight for reasons for a TTT after a Dx of POTS.
  20. ahimsa

    ahimsa Senior Member

    Messages:
    1,046
    Likes:
    904
    Oregon, USA
    I agree with what Sushi posted. The only other reason I can think of for taking the test is for additional medical evidence to support a claim for disability insurance benefits. But that is probably not something the doctor is even thinking about.

See more popular forum discussions.

Share This Page