93660 Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention

Name of the Procedure:

Tilt Table Evaluation with Continuous ECG Monitoring and Intermittent Blood Pressure Monitoring, with or without Pharmacological Intervention

Summary

The tilt table evaluation is a diagnostic procedure used to assess cardiovascular function. It involves tilting the patient at various angles while continuously monitoring the heart's electrical activity (ECG) and intermittently measuring blood pressure. Sometimes, medications may be administered to observe their effects on heart rate and blood pressure.

Purpose

• Condition Addressed: This test is often used to diagnose the cause of unexplained fainting (syncope), dizziness, or light-headedness.
• Goals: To identify abnormal responses in heart rate and blood pressure when the body changes position from lying down to standing up.

Indications

• Recurrent fainting (syncope) of unknown origin
• Orthostatic hypotension (a significant drop in blood pressure upon standing)
• Unexplained dizziness or light-headedness
• Monitoring the effectiveness of therapeutic measures

Preparation

• Fasting: Patients are typically asked to fast for a few hours before the test.
• Medication: Certain medications might need to be adjusted or withheld as per the doctor's instructions.
• Pre-tests: Basic diagnostic tests such as ECG, blood tests, or a detailed medical history review may be required.

Procedure Description

1. Initial Setup: The patient lies flat on a motorized tilt table.
2. Monitoring: Continuous ECG electrodes are attached, and a blood pressure cuff is placed for intermittent measurements.
3. Tilting: The table gradually tilts the patient to an almost upright position (60-80 degrees).
4. Observation: Heart rate and blood pressure are monitored for any abnormal changes.
5. Intervention: If necessary, medications (like isoproterenol) are administered to provoke a response for further evaluation.
6. Recording: All data is recorded for analysis.
7. Return: The table is returned to the flat position, and monitoring continues for a short period.

Duration

The entire procedure usually takes about 60 to 90 minutes.

Setting

The procedure is conducted in a controlled environment such as a hospital's cardiology or electrophysiology lab, or an outpatient clinic specialized in cardiovascular diagnostics.

Personnel

• Cardiologist or electrophysiologist
• Specialized nurses or technicians
• Pharmacologist or additional medical personnel as needed

Risks and Complications

• Common Risks: Dizziness, fainting, nausea during the test.
• Rare Risks: Severe drops in blood pressure, arrhythmias, possible allergic reaction to medications.
• Management: Immediate medical intervention is available to manage complications.

Benefits

• Accurate diagnosis of the underlying cause of syncope or dizziness.
• Helps guide appropriate treatment plans.
• Non-invasive with minimal risk.

Recovery

• Post-Procedure Care: Patients can usually resume normal activities shortly after the procedure unless otherwise instructed by the healthcare provider.
• Recovery Time: Typically, only a brief period of observation is required afterward.
• Follow-Up: Any necessary follow-up appointments or further testing will be scheduled based on the results.

Alternatives

• Other Options: Head-up tilt testing, lying and standing blood pressure measurements, ambulatory blood pressure monitoring.
• Pros and Cons: Alternative methods might be less invasive but also less comprehensive in diagnosing certain conditions.

Patient Experience

• During the Procedure: Patients may experience mild discomfort from being tilted, and medications may cause temporary sensations such as warmth or increased heart rate.
• After the Procedure: Light-headedness may persist for a short period; healthcare providers will ensure all symptoms are managed before discharge. Pain management and comfort measures, like providing a calm environment, are prioritized.