I firmly believe the tilt test, or rather the “Poor Man's Tilt Test”, should be a standard part of all regular physical examinations, starting with school age children. This is something you can also do at home and then take the results to discuss with your doctor. Borrowing a chart from the DynaKids website, I am gonna tell you how to do this…bear in mind, this is the advice of a patient, not a doctor. All you need is a blood pressure cuff and a writing implement and this printed chart or just a piece of blank paper. Ready? (You can get the full size image by clicking on it.)
I recommend doing at least the first part (the ten minute test). Please note that it is a good idea to have another person around in case you do pass out, and do this near a bed or sofa and away from any furniture or sharp edges/objects that you could injure yourself on if you do fall out. You should measure your bp with your palm facing up, arm extended at heart level resting on a table or shelf or stack of pillows…something to keep it properly aligned and in a relaxed state.
DO NOT FIDGET. No talking. No flexing or tightening of leg muscles or tushie muscles (many of us do this stuff unconsciously as a defense mechanism so pay close attention to your body). If you are on any medications, such as beta blockers, your test will be affected. You might see, as an example, an abrupt bout of tachycardia (increased heart rate) followed by relative stabilization (induced by the meds).
Disclaimer: please do not take this as medical advice without seeking the medical opinion of at least one qualified doctor. This is not a substitute for actual medical care.
Poor Man's Tilt Test
Just lay down flat for an hour and remain calm. Then take your bp and heart rate while still lying flat. I do this with my arm extended outright and my hand resting on something (pillow) so that my arm is relaxed. I try to simulate how they do it at the doctors office.
All you need is a bp + heartrate cuff and something to write close by.
Next stand up straight and don't move except to take your bp. Take it at 1 min, 2 min, 3 min and then 10 minutes. At each interval, write down your BP and heart rate. This is very important! In many cases, you will see a rise (tachycardia) very quickly…often does not take the full ten minutes, but may continue to rise so it is important to keep going for the full ten minutes.
- A 20 pt drop in your bp 3 within minutes means you have orthostatic intolerance.
- A 30 pt increase in heart rate within 10 minutes indicates POTS.
(the chart gives similar instructions…you can do it either way, really)
Testing for NMH will require you to stand up longer. See further below.
* A word of caution on the 10 minute test .. I was close to passing out and it took me an hour at least to recover fully. Of course if you feel faint, stop and ask someone to help you.
Neurally Mediated Hypotension (NMH)
This is harder to detect on a PMTTat home. You may need to stand as long as 45 minutes for this part… 10 minutes of standing may not be long enough to detect NMH. Someone trying to do this test at home might think they were being still enough but might be moving around or fidgeting more than they realize. Don't talk, fidget, tense any muscles, or lock your knees. Being still and neutral is crucial.
*** I also recommend having someone around when you do this…and I do it standing next to my bed so I have a soft landing place to try to aim for if I begin to black out.
An extract fr the Johns Hopkins document on Orthostatic Intolerance:
NMH and POTS cannot be detected with routine, resting blood pressure or heart rate screening. The diagnoses can be made with a prolonged standing test or a tilt table test. Although a 10-minute test is all that is needed to diagnose POTS, this is too brief for diagnosing NMH, which usually requires at least a 45-minute period of upright posture.
Many hospitals and academic centers throughout the world perform tilt table testing. It allows careful measurement of the heart rate and blood pressure responses to the head-up position, usually at a 70-degree angle, in an almost standing position. The usual reason for performing a tilt table test in the past had been for the evaluation of recurrent fainting.
Many people with NMH develop adaptations to keep from fainting, such as crossing their legs, fidgeting, or sitting or lying down when they get lightheaded or tired. However, during the tilt table test they must remain still, and they cannot call upon these natural defenses.
As a result, fainting can occur for the first time during the tilt table test. Increased fatigue and malaise often occur for a few days after the test is performed, although our experience has suggested that these symptoms can be minimized if the individual is treated with intravenous saline solutions immediately after completion of the tilt test. I'm not at all trying to say that everyone out there needs to get a tilt table test. I'm just saying that this home testing may not reveal anything for a certain subset of OI patients.