95924 Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt

Name of the Procedure:

Combined Parasympathetic and Sympathetic Adrenergic Function Testing (Tilt Table Test)

Summary

The combined parasympathetic and sympathetic adrenergic function testing, commonly known as the tilt table test, assesses the autonomic nervous system by monitoring heart rate and blood pressure while the patient is tilted at different angles, including a passive tilt for at least five minutes. This helps to determine how well the autonomic nervous system regulates these functions during changes in body position.

Purpose

This procedure addresses issues related to dysautonomia, a condition where the autonomic nervous system does not function properly. The goals are to diagnose conditions like postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope, and autonomic failure, and to guide appropriate treatment plans.

Indications

• Unexplained fainting or syncope
• Persistent dizziness or lightheadedness
• Chronic fatigue
• POTS symptoms (e.g., heart palpitations, excessive sweating)
• Signs of autonomic neuropathy in patients with diabetes or other systemic diseases

Preparation

• Patients may be instructed to fast for a few hours before the test.
• Medication adjustments might be necessary; patients should consult their doctor.
• Wear comfortable clothing and avoid consuming caffeine or alcohol 24 hours prior.
• Initial diagnostic tests such as blood work or an ECG may be required.

Procedure Description

1. The patient lies flat on a specialized tilt table, and baseline heart rate and blood pressure are recorded.
2. The table is tilted to various angles, often starting at 30 degrees and increasing to 60-70 degrees.
3. Patients will remain passive (e.g., not actively adjusting their position) for at least five minutes at each angle.
4. Continuous monitoring of heart rate, blood pressure, and sometimes blood oxygen levels.
5. The table is gradually returned to a horizontal position.
   • Equipment used includes a tilt table, ECG machine, blood pressure monitor, and possibly a continuous blood oxygen monitor.
   • Generally, no anesthesia or sedation is required.

Duration

The procedure typically lasts about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or specialized autonomic testing center.

Personnel

• Cardiologist or neurologist overseeing the test
• Trained nurse or technician operating the tilt table and monitoring equipment

Risks and Complications

• Common risks: mild dizziness, nausea, or lightheadedness
• Rare risks: prolonged fainting, low blood pressure, or arrhythmias
• Emergency measures, such as IV fluids or medications, are on standby in case of complications.

Benefits

• Accurate diagnosis of autonomic disorders
• Enhanced understanding of symptoms leading to more targeted treatments
• Non-invasive and relatively low-risk procedure
• Patients often realize benefits within days to weeks as treatment plans are adjusted.

Recovery

• Patients can usually resume normal activities immediately post-test.
• Post-procedure instructions include hydration and avoiding sudden movements.
• Follow-up appointments may be necessary to discuss results and treatment options.

Alternatives

• 24-hour Holter monitoring for continuous ECG recording.
• Blood pressure monitoring over 24 hours.
• Autonomic nervous system function tests like the Valsalva maneuver or deep breathing tests.
• Pros of alternatives: continuous data collection, minimal patient discomfort.
• Cons of alternatives: may not provide comprehensive data specific to positional changes.

Patient Experience

During the procedure, patients might feel mild to moderate dizziness or discomfort when tilted. Afterward, some may experience fatigue or mild dizziness, which generally resolves quickly. The healthcare team will provide measures to ensure comfort and manage any discomfort promptly.