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Why Is A Tilt Table Test Advised?
Brief Answer:
Syncope and other cardiac events
Detailed Answer:
Hi
Firstly thanks for choosing health care magic for your query,
Tilt table tests is used to find out why people feel faint or lightheaded or actually completely pass out.Its used to diagnose the causes of Syncope.In lay mans language it can be used to see if fainting is due to abnormal control of heart rate(slow heart rate as in Bradycardia) or blood pressure(Hypotension).
Patients with symptoms of dizziness or lightheadedness, with or without a loss of consciousness (fainting;syncope), suspected to be associated with a drop in blood pressure or positional tachycardia are good candidates for this test.
A cardiac MRI is used to diagnose several conditions. Some common of these include:
congenital heart defects
coronary heart disease-damage from a heart attack
congestive heart failure
Heart tumors and growths
heart valve defects
inflammation of the membrane around the heart (pericarditis)
Amyloidosis in heart.
In case you have any more query feel free to ask!
Thank you,
Dr Rishu Saxena
Cardiologist
Syncope and other cardiac events
Detailed Answer:
Hi
Firstly thanks for choosing health care magic for your query,
Tilt table tests is used to find out why people feel faint or lightheaded or actually completely pass out.Its used to diagnose the causes of Syncope.In lay mans language it can be used to see if fainting is due to abnormal control of heart rate(slow heart rate as in Bradycardia) or blood pressure(Hypotension).
Patients with symptoms of dizziness or lightheadedness, with or without a loss of consciousness (fainting;syncope), suspected to be associated with a drop in blood pressure or positional tachycardia are good candidates for this test.
A cardiac MRI is used to diagnose several conditions. Some common of these include:
congenital heart defects
coronary heart disease-damage from a heart attack
congestive heart failure
Heart tumors and growths
heart valve defects
inflammation of the membrane around the heart (pericarditis)
Amyloidosis in heart.
In case you have any more query feel free to ask!
Thank you,
Dr Rishu Saxena
Cardiologist
Above answer was peer-reviewed by :
Dr. Remy Koshy
Would either of these tests be able to pick up something that was not seen on an echo? I thought the echo was the best test.
Could it help determine a cause of shortness of breath that improves when lying flat or SOB/tachycardia when going up stairs and bending or pulling? Like if it was related to a flow issue?
Could it help determine a cause of shortness of breath that improves when lying flat or SOB/tachycardia when going up stairs and bending or pulling? Like if it was related to a flow issue?
Brief Answer:
all tests are totally different echo is more sensitive for CHF.
Detailed Answer:
Hi again,
shortness of breath is medically called as dyspnoea on exertion and you are in stage 2 dyspnoea as per your symptoms.
Tilt test is usually done to rule out the cause of dizziness,syncope, principle of 2d echo and tilt tests are totally different.
2d echo helps you to see the motion of the walls of the heart,left ventricle ejection fraction,valves functioning, whether there is stagnation or backflow of blood from heart to lungs(causing breathlessness)
If syncope and dizziness is not your primary problem ,HUTT is not going to help you, rather you should go for
2d echo - flow of blood can be seen.
tread mill test( ischemia to heart causes chf leading to shortness of breath)
Pulmonary function test ( to differenciate cardiac cause from respiratory cause)
A cardiac MRI and HUTT are totally different from echo ,it depends on what your symptoms are and what your diagnosis is ,to decide which test to do.
A cardiac MRI is usually done for amyloidosis and to rule out tumour , its not a usual test for dyspnoea patient.
In case you need more details message me your symptoms!
Thank you ,
Dr Rishu Saxena
all tests are totally different echo is more sensitive for CHF.
Detailed Answer:
Hi again,
shortness of breath is medically called as dyspnoea on exertion and you are in stage 2 dyspnoea as per your symptoms.
Tilt test is usually done to rule out the cause of dizziness,syncope, principle of 2d echo and tilt tests are totally different.
2d echo helps you to see the motion of the walls of the heart,left ventricle ejection fraction,valves functioning, whether there is stagnation or backflow of blood from heart to lungs(causing breathlessness)
If syncope and dizziness is not your primary problem ,HUTT is not going to help you, rather you should go for
2d echo - flow of blood can be seen.
tread mill test( ischemia to heart causes chf leading to shortness of breath)
Pulmonary function test ( to differenciate cardiac cause from respiratory cause)
A cardiac MRI and HUTT are totally different from echo ,it depends on what your symptoms are and what your diagnosis is ,to decide which test to do.
A cardiac MRI is usually done for amyloidosis and to rule out tumour , its not a usual test for dyspnoea patient.
In case you need more details message me your symptoms!
Thank you ,
Dr Rishu Saxena
Above answer was peer-reviewed by :
Dr. Remy Koshy
Does it mean anything that when I get a hot shower my heart rate really goes up. From 70-80s to 130-140s? Then when I lay down it comes down rapidly.
When I have random episodes of tachycardia and I lay down sometimes my heart pauses and immediately drops to a normal rate. I have listened through a stethoscope and measured my heart rate. It will go from 115 or so to 70. My blood pressure remains stable.
Also, my heart rate goes up immediately when going up stairs. From 70s to 120-130 up 2 flight of stairs. I get shortness of breath as well. I do not have shortness of breath when I lay flat.
Also how important is diastolic pressure? Mine is normally 70-80s but sometimes when I get dizzy its in the 50s. I know most doctors look at systolic but my diastolic pressure fluctuates more.
When I have random episodes of tachycardia and I lay down sometimes my heart pauses and immediately drops to a normal rate. I have listened through a stethoscope and measured my heart rate. It will go from 115 or so to 70. My blood pressure remains stable.
Also, my heart rate goes up immediately when going up stairs. From 70s to 120-130 up 2 flight of stairs. I get shortness of breath as well. I do not have shortness of breath when I lay flat.
Also how important is diastolic pressure? Mine is normally 70-80s but sometimes when I get dizzy its in the 50s. I know most doctors look at systolic but my diastolic pressure fluctuates more.
Brief Answer:
Details below.
Detailed Answer:
Hi
As per your history both your blood pressure and heart rate keeps on fluctuating a thorough investigation is required to rule out the cause of this problem.
i would suggest you to go for some basic tests of cardiology
2 d echo, tread mill test, 24 hour holter monitoring, Carotid artery doppler and HUTT test.
A comment on your symptoms can be made only after going through the reports of all these investigations.
Heart rate rising from 70 to 130 in going 2 flights of stairs is abnormal , this is associated with shortness of breath called dyspnoe on exertion medically.
24 hour holter will record your beats during episodes of tachycardia, as we have to know the rate and rythm at the time of tachycardia; it can be a normal palpitation or it can be even life threatning arrythmia, 24 hour holter monitor will help to find out the nature of palpitations.
Hot shower causes increase in your body temperature , sudden increase in your body temperature causes dilatation of vessels in periphery ,to lower down temperature to normal again, hence to maintain the blood pressure heart start beating faster.
A complete explaination can be given only after detailed investigations.
Diastolic blood pressure refers to the pressure that is exerted on the walls of the various arteries around the body in between heart beats when the heart is relaxed ,Dizziness due to lower diastole means you are symptomatic and there is some problem with you heart as it is unable to maintain blood pressure .
Details below.
Detailed Answer:
Hi
As per your history both your blood pressure and heart rate keeps on fluctuating a thorough investigation is required to rule out the cause of this problem.
i would suggest you to go for some basic tests of cardiology
2 d echo, tread mill test, 24 hour holter monitoring, Carotid artery doppler and HUTT test.
A comment on your symptoms can be made only after going through the reports of all these investigations.
Heart rate rising from 70 to 130 in going 2 flights of stairs is abnormal , this is associated with shortness of breath called dyspnoe on exertion medically.
24 hour holter will record your beats during episodes of tachycardia, as we have to know the rate and rythm at the time of tachycardia; it can be a normal palpitation or it can be even life threatning arrythmia, 24 hour holter monitor will help to find out the nature of palpitations.
Hot shower causes increase in your body temperature , sudden increase in your body temperature causes dilatation of vessels in periphery ,to lower down temperature to normal again, hence to maintain the blood pressure heart start beating faster.
A complete explaination can be given only after detailed investigations.
Diastolic blood pressure refers to the pressure that is exerted on the walls of the various arteries around the body in between heart beats when the heart is relaxed ,Dizziness due to lower diastole means you are symptomatic and there is some problem with you heart as it is unable to maintain blood pressure .
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you so much for your explanations. Sounds like a tilt test wouldn't really be helpful for me. And unfortunately I don't know how much the echo would tell either because you lay flat when you get it, and that's when I feel the best. Plus I had one before I was told before that I had a good ejection fraction. How can I have all these symptoms and an echo be normal??
One last question
What causes people with heart issues to become short of breath when bending over or carrying things like groceries? And I guess going upstairs is worse because you are using your leg muscles? I experience this all the time.
One last question
What causes people with heart issues to become short of breath when bending over or carrying things like groceries? And I guess going upstairs is worse because you are using your leg muscles? I experience this all the time.
Brief Answer:
It can be respiratory or anaemia.
Detailed Answer:
Hi,
If your echo is normal,in that case breathlessness can be because of Respiratory cause , more over relief in breathlessness on lying flat is very unlikely to be of cardiac origin .
so my suggestion
Pulmonary function test-rule out obstructive and restrictive lung disease.
Haemoglobin (anaemia causes breathlessness and tachycardia both -and on lying flat blood return to heart increases therefore breathlessness and tachycardia settles down),Anaemia is a very common and usually missed diagnosis.
In people with cardiac disease the forward flow of blood is hampered and hence blood starts to stagnate in heart and after some time it regurgitates back into lungs,so space in lung meant for air is occupied by fluid causing breathlessness.
When you bend down fluid at the base of the lungs moves to the full lung hence increasing breathlessness.
Thanks,
Dr Rishu Saxena
Cardiologist
( YYYY@YYYY )
It can be respiratory or anaemia.
Detailed Answer:
Hi,
If your echo is normal,in that case breathlessness can be because of Respiratory cause , more over relief in breathlessness on lying flat is very unlikely to be of cardiac origin .
so my suggestion
Pulmonary function test-rule out obstructive and restrictive lung disease.
Haemoglobin (anaemia causes breathlessness and tachycardia both -and on lying flat blood return to heart increases therefore breathlessness and tachycardia settles down),Anaemia is a very common and usually missed diagnosis.
In people with cardiac disease the forward flow of blood is hampered and hence blood starts to stagnate in heart and after some time it regurgitates back into lungs,so space in lung meant for air is occupied by fluid causing breathlessness.
When you bend down fluid at the base of the lungs moves to the full lung hence increasing breathlessness.
Thanks,
Dr Rishu Saxena
Cardiologist
( YYYY@YYYY )
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
So there are no cardiac conditions that improve with lying flat?
Brief Answer:
yes except in rare cases.
Detailed Answer:
Hi,
First rule of medical science is that there is no rule, every body is different. Exceptions are rare but are there, a doctor does what's written in the text book. So answer to your question is yes normally (99%) of cases, a cardiac cause of breathlessness increases on lying down.
Secondly, apart from ejection fraction , the function of aortic , mitral , pulmonary valve decides the cause of breathlessness; I would like to go through your echo report.
If you want you can mail it to me.
Without the reports of
1) PFT
2) 2D ECHO
It's very difficult to say if in your case cause is cardiac or respiratory
Thanks
yes except in rare cases.
Detailed Answer:
Hi,
First rule of medical science is that there is no rule, every body is different. Exceptions are rare but are there, a doctor does what's written in the text book. So answer to your question is yes normally (99%) of cases, a cardiac cause of breathlessness increases on lying down.
Secondly, apart from ejection fraction , the function of aortic , mitral , pulmonary valve decides the cause of breathlessness; I would like to go through your echo report.
If you want you can mail it to me.
Without the reports of
1) PFT
2) 2D ECHO
It's very difficult to say if in your case cause is cardiac or respiratory
Thanks
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
They said my PFTs were normal.
My echo report and stress test are:
Indications: Primary Pulmonary Hypertension
Study Components: 2D Color Doppler Spectral
BP: 118 / 82 HR: 70 Rhythm: Sinus
Technical Quality:Good
MEASUREMENTS (Male / Female) Normal Values
2D ECHO
LV Diastolic Diameter PLA 4.2 cm 3.7 - 5.6 cm Aortic Root Diameter 2.8 cm 2.0 - 3.7 cm
LV Systolic Diameter PLAX 2.8 cm 2.0 - 4.0 cm LA Systolic Diameter LX 3.6 cm 1.9 - 4.0 cm
LV Fractional Shortening 33.3 % 28 - 46 % LV Diastolic Volume MOD B 84.0 cm³ 67 - 155 / 56 - 104 cm³
LVPW Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Ejection Fraction MOD 63.1 % >= 55 %
IVS Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Stroke Volume MOD BP 53.0 cm³
RV Internal Dimension 2.1 cm 0.7 - 2.6 cm
DOPPLER
AV Peak Velocity 1.3 m/s MV Deceleration Time 238.0 ms
AV Peak Gradient 7.0 mmHg LV E' Lateral Velocity 17.3 cm/s
Mitral E Point Velocity 0.8 m/s Mitral E to LV E' Lateral 4.8
Mitral A Point Velocity 0.6 m/s TR Peak Velocity 1.9 m/s
Mitral E to A Ratio 1.3 TR Peak Gradient 14.4 mmHg
INTERPRETATIONS
Left Ventricle Normal left ventricular size and wall thickness with preserved systolic function. Ejection fraction 63%. No
wall motion abnormalities. Normal diastolic filling pattern.
Right Ventricle Normal right ventricular size and systolic function.
Right Atrium Normal size right atrium.
Interatrial Septum Cannot rule out PFO with minimal left-to-right shunt by color Doppler.
Left Atrium Normal size left atrium.
Mitral Valve Structurally normal mitral valve with trace mitral regurgitation.
Aortic Valve Tricuspid aortic valve with no flow abnormality.
Tricuspid Valve Trace tricuspid regurgitation with normal right ventricular systolic pressure.
Pulmonic Valve Trace pulmonic regurgitation.
Pericardium No significant effusion.
Aorta Not well visualized.
Other Normal IVC size with normal respiratory collapse.
CONCLUSION
1. Normal left ventricular size with preserved systolic function. Ejection fraction 63%. No wall motion abnormalities. Normal
diastolic filling pattern.
2. Trace mitral regurgitation.
3. Tricuspid aortic valve with no flow abnormality.
4. Normal right ventricular systolic function. Trace tricuspid regurgitation with normal right ventricular systolic pressure.
The Patient exercised for 6 minutes and 31 seconds to 88 %
Maximal Predicted Heart Rate on the XXXXXXX Protocol with a PRP of
21.6 and peak exertion of 7.7 METS.
Resting BP: 94/56 Maximum BP: 132/68
Resting HR: 75 Peak HR: 164
The test was stopped for sensation that she could not take in a
deep breath.
Blood pressure response was flat.
Functional capacity was 27 %impaired.
Dyspnea was moderate.
There was no chest pain.
With exercise there was no significant ST depression.
Resting EKG: Normal sinus rhythm. Normal EKG..
There was no arrhythmia noted with exercise.
The ECG was negative for ischemia.
My echo report and stress test are:
Indications: Primary Pulmonary Hypertension
Study Components: 2D Color Doppler Spectral
BP: 118 / 82 HR: 70 Rhythm: Sinus
Technical Quality:Good
MEASUREMENTS (Male / Female) Normal Values
2D ECHO
LV Diastolic Diameter PLA 4.2 cm 3.7 - 5.6 cm Aortic Root Diameter 2.8 cm 2.0 - 3.7 cm
LV Systolic Diameter PLAX 2.8 cm 2.0 - 4.0 cm LA Systolic Diameter LX 3.6 cm 1.9 - 4.0 cm
LV Fractional Shortening 33.3 % 28 - 46 % LV Diastolic Volume MOD B 84.0 cm³ 67 - 155 / 56 - 104 cm³
LVPW Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Ejection Fraction MOD 63.1 % >= 55 %
IVS Diastolic Thickness 0.9 cm 0.6 - 1.1 cm LV Stroke Volume MOD BP 53.0 cm³
RV Internal Dimension 2.1 cm 0.7 - 2.6 cm
DOPPLER
AV Peak Velocity 1.3 m/s MV Deceleration Time 238.0 ms
AV Peak Gradient 7.0 mmHg LV E' Lateral Velocity 17.3 cm/s
Mitral E Point Velocity 0.8 m/s Mitral E to LV E' Lateral 4.8
Mitral A Point Velocity 0.6 m/s TR Peak Velocity 1.9 m/s
Mitral E to A Ratio 1.3 TR Peak Gradient 14.4 mmHg
INTERPRETATIONS
Left Ventricle Normal left ventricular size and wall thickness with preserved systolic function. Ejection fraction 63%. No
wall motion abnormalities. Normal diastolic filling pattern.
Right Ventricle Normal right ventricular size and systolic function.
Right Atrium Normal size right atrium.
Interatrial Septum Cannot rule out PFO with minimal left-to-right shunt by color Doppler.
Left Atrium Normal size left atrium.
Mitral Valve Structurally normal mitral valve with trace mitral regurgitation.
Aortic Valve Tricuspid aortic valve with no flow abnormality.
Tricuspid Valve Trace tricuspid regurgitation with normal right ventricular systolic pressure.
Pulmonic Valve Trace pulmonic regurgitation.
Pericardium No significant effusion.
Aorta Not well visualized.
Other Normal IVC size with normal respiratory collapse.
CONCLUSION
1. Normal left ventricular size with preserved systolic function. Ejection fraction 63%. No wall motion abnormalities. Normal
diastolic filling pattern.
2. Trace mitral regurgitation.
3. Tricuspid aortic valve with no flow abnormality.
4. Normal right ventricular systolic function. Trace tricuspid regurgitation with normal right ventricular systolic pressure.
The Patient exercised for 6 minutes and 31 seconds to 88 %
Maximal Predicted Heart Rate on the XXXXXXX Protocol with a PRP of
21.6 and peak exertion of 7.7 METS.
Resting BP: 94/56 Maximum BP: 132/68
Resting HR: 75 Peak HR: 164
The test was stopped for sensation that she could not take in a
deep breath.
Blood pressure response was flat.
Functional capacity was 27 %impaired.
Dyspnea was moderate.
There was no chest pain.
With exercise there was no significant ST depression.
Resting EKG: Normal sinus rhythm. Normal EKG..
There was no arrhythmia noted with exercise.
The ECG was negative for ischemia.
Brief Answer:
PULMONARY CAUSE
Detailed Answer:
Hi
Your breathlessness has nothing to do with your heart, so go for a pulmonary function test, it can be either a restrictive or obstructive lung disease.
While going through your 2d echo and tmt tests , one thing which i found strange is that
Resting BP: 94/56 while doing stress test and
BP: 118 / 82 while doing echo.
A variation of more than 20mm of hg systolic and ~ 30 mm of hg diastolic ?
Do you have labile blood pressure ?
Please Reply at the earliest.
Thanks
PULMONARY CAUSE
Detailed Answer:
Hi
Your breathlessness has nothing to do with your heart, so go for a pulmonary function test, it can be either a restrictive or obstructive lung disease.
While going through your 2d echo and tmt tests , one thing which i found strange is that
Resting BP: 94/56 while doing stress test and
BP: 118 / 82 while doing echo.
A variation of more than 20mm of hg systolic and ~ 30 mm of hg diastolic ?
Do you have labile blood pressure ?
Please Reply at the earliest.
Thanks
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Yes it changes. Sometimes my diastolic is in the 50s sometimes 80s. My systolic is anywhere from 90s to 120. Up to 135 if I am exerting myself. They tell me I have a flat blood pressure response. I am not sure what that means
Brief Answer:
Adrenal supression
Detailed Answer:
Hi,
Lets first understand how blood pressure is maintained by our body, this will help you to understand your symptoms better.
Our kidney on top of them have two small glands called ADRENAL, these glands are responsible for secretion of hormones named ALDOSTERONE , CORTISOL etc.
Aldosterone along with Cortisol affects the body's ability to regulate blood pressure. It plays a pivotal role in maintaining blood pressure constant through out the day. It sends signal to organs, like the kidney and colon, that can increase the amount of sodium(sodium retains water and can increase blood pressure if there is a drop in blood pressure) the body sends into the bloodstream or the amount of potassium released in the urine.
Aldosterone is closely linked to two other hormones: renin and angiotensin, which create the renin-angiotensin-aldosterone system. This system is activated when the body experiences a decrease in blood flow to the kidneys, such as after a drop in blood pressure, and maintains the blood pressure to normal again.
Adrenal suppression is one of the most common cause of labile blood pressure.
Advice
.........
A) ACTH (hormone secreted by pituitary that stimulate adrenal gland to produce hormone) stimulation test-- Commonly used test for diagnosing adrenal insufficiency. You would be given an intravenous injection of synthetic ACTH, and samples of blood, urine, or both are taken before and after the injection. The cortisol levels in the blood and urine samples are measured in a lab.
B) CRH stimulation test-- When the response to the ACTH test is abnormal, a CRH stimulation test can help determine the cause of adrenal insufficiency. In this, you would be given an IV injection of synthetic CRH, and blood is taken before and 30, 60, 90, and 120 minutes after the injection. The cortisol levels in the blood samples are measured in a lab.
C) serum renin and aldosterone levels will be done
D) MRI of abdomen can be done to rule out any atrophy (and/ injury) to adrenals
Labile blood pressure is either due to heart(normal in your case), or adrenals .
If your diastole reaches as low as 50mm of hg (not a good sign), you should consider this seriously,
Thanks
Adrenal supression
Detailed Answer:
Hi,
Lets first understand how blood pressure is maintained by our body, this will help you to understand your symptoms better.
Our kidney on top of them have two small glands called ADRENAL, these glands are responsible for secretion of hormones named ALDOSTERONE , CORTISOL etc.
Aldosterone along with Cortisol affects the body's ability to regulate blood pressure. It plays a pivotal role in maintaining blood pressure constant through out the day. It sends signal to organs, like the kidney and colon, that can increase the amount of sodium(sodium retains water and can increase blood pressure if there is a drop in blood pressure) the body sends into the bloodstream or the amount of potassium released in the urine.
Aldosterone is closely linked to two other hormones: renin and angiotensin, which create the renin-angiotensin-aldosterone system. This system is activated when the body experiences a decrease in blood flow to the kidneys, such as after a drop in blood pressure, and maintains the blood pressure to normal again.
Adrenal suppression is one of the most common cause of labile blood pressure.
Advice
.........
A) ACTH (hormone secreted by pituitary that stimulate adrenal gland to produce hormone) stimulation test-- Commonly used test for diagnosing adrenal insufficiency. You would be given an intravenous injection of synthetic ACTH, and samples of blood, urine, or both are taken before and after the injection. The cortisol levels in the blood and urine samples are measured in a lab.
B) CRH stimulation test-- When the response to the ACTH test is abnormal, a CRH stimulation test can help determine the cause of adrenal insufficiency. In this, you would be given an IV injection of synthetic CRH, and blood is taken before and 30, 60, 90, and 120 minutes after the injection. The cortisol levels in the blood samples are measured in a lab.
C) serum renin and aldosterone levels will be done
D) MRI of abdomen can be done to rule out any atrophy (and/ injury) to adrenals
Labile blood pressure is either due to heart(normal in your case), or adrenals .
If your diastole reaches as low as 50mm of hg (not a good sign), you should consider this seriously,
Thanks
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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