Table 3.
The characteristics of the patterns associated with the tilt test.
Disorder/syndrome | HR | BP | CBFv | ETCO2 | Comments | ||||
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Supine | Tilt | Supine | Tilt | Supine | Tilt | Supine | Tilt | ||
Orthostatic hypotension (OH), compensated, with stable orthostatic CBFv | ↔ | ↕ | ↕ | ↓∗ | ↔ | ↔ | ↔ | ↔ | OH with stable orthostatic CBFv indicating preserved cerebral autoregulation. OH can have any pattern: early, late, sustained, intermittent, progressive, stable. Patients are typically not dizzy during the tilting |
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OH, uncompensated, with reduced orthostatic CBFv | ↔ | ↕ | ↕ | ↓∗ | ↔ | ↓ | ↔ | ↔ | OH with reduced orthostatic CBFv indicating either autoregulatory failure or BP below the autoregulatory range. Patients are typically dizzy during the tilting |
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Orthostatic cerebral hypoperfusion syndrome (OCHOs) | ↔ | ↔ | ↕ | ↔ | ↔ | ↓∗ | ↔ | ↔ | Orthostatic CBFv is low without OH or arrhythmia. Patients are typically dizzy during the tilting |
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Orthostatic hypertension syndrome (OHTN) | ↔ | ↔ | ↕ | ↑∗ | ↔ | ↔↑ | ↔ | ↔ | If HR increases ≥30 BPM during the tilt then it is POTS. If HR increases <30 BPM and CBFv decreases during the tilt then it is OCHOs |
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Postural tachycardia syndrome (POTS) | ↔ | ↑∗ | ↔↓ | ↔↑ | ↔ | ↔↓ | ↔ | ↔ or HV | HR increase during the tilt is usually sustained. HR ≥ 120 BPM during the tilt is also required. If maximal HR < 120 BPM during the tilt then it is called “mild orthostatic intolerance” |
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Inappropriate sinus tachycardia (IST) | ↑∗ | ↑∗ | ↔↑ | ↔↑ | ↔ | ↔ | ↔ | ↔ | HR during the supine may fluctuate but mean HR > 100 BPM during supine. HR is increased during the tilt and the increase is usually fluctuating |
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Paroxysmal sinus tachycardia (PST) | ↔↑ | ↑∗ | ↕ | ↔↑ | ↔ | ↔↑ | ↔ or HV | ↔ or HV | HR increase which may happen during both supine and the tilt is usually intermittent and associated with anxiety and may respond to reassurance |
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Syncope, cardiovagal | ↔ | ↓ | ↔ | ↓∗ | ↔ | ↓ | ↔ | ↕ | HR < 40 BPM |
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Syncope, vasodepressor | ↔ | ↔↑ | ↔ | ↓∗ | ↔ | ↓ | ↔ | ↕ | Minimal HR slowing (<10%) |
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Syncope, mixed | ↔ | ↓ | ↔ | ↓∗ | ↔ | ↓ | ↔ | ↕ | Both HR and BP decrease |
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Primary cerebral autoregulatory failure (pCAF) | ↔ | ↔ | ↔↑ | ↔ | ↓∗ | ↔↓ | ↔ | ↔ | Hyperventilation should be ruled out |
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Psychogenic pseudosyncope | ↕ | ↕ | ↕ | ↕ | ↔∗ | ↔∗ | ↕ | ↕ | Pseudosyncope can occur in both supine and upright position |
Comments: CBFv = cerebral blood flow velocity; ETCO2 = end tidal CO2; HR = heart rate; BP = blood pressure; BPM = beats per minute; supine = absolute values of respective variables in supine position; tilt = absolute values of respective variables during the tilt (upright position); HV = hyperventilation defined as ETCO2 < 35 mmHg in supine position and < 30 mmHg during the tilt; CAF = cerebral autoregulatory failure; ↑ = increased; ↓ = decreased; ↕ = any; ↔ normal; ↔↑ = normal or increased; ↔↓ = normal or decreased. ∗ indicates the primary abnormality.