Clinical Autonomic Research

, Volume 29, Issue 2, pp 215–230 | Cite as

Autonomic uprising: the tilt table test in autonomic medicine

  • William P. CheshireJr.Email author
  • David S. Goldstein
Review Article


This perspective piece on head-up tilt table testing is part of a series on autonomic function testing. The tilt table can be a useful diagnostic test, but methodologies vary, and the results are sometimes misinterpreted. The intent here is not to review comprehensively the utility of various tilt table testing protocols but to convey a number of general points that may give perspective and have practical clinical value, based on an understanding of autonomic physiology and our long clinical and research experience in the evaluation of autonomic disorders. The goals of tilt table testing are to assess orthostatic hypotension (OH), chronic orthostatic intolerance (COI), and unexplained syncope. The testing is useful for distinguishing neurogenic from non-neurogenic OH, identifying failure of the sympathetic noradrenergic system in autonomic neuropathies and ganglionopathies, and assessing baroreflex-sympathoneural function in α-synucleinopathies. For COI, the testing can provide objective data related to the patient’s symptoms, diagnose postural tachycardia syndrome (POTS), and distinguish POTS from other causes of tachycardia. Provocative tilt table testing can help understand bases for recurrent transient loss of consciousness in patients with syncope, distinguish neurally mediated syncope from psychogenic pseudosyncope, and separate syncope-related convulsion from epileptic seizures. For each of these purposes, the goals, formats, endpoints, and clinical utility are different. As for any autonomic test, tilt table findings must be interpreted in the context of the patient’s clinical presentation.


Orthostatic intolerance Orthostatic hypotension Tilt table testing Syncope Vasovagal syncope Postural orthostatic tachycardia syndrome Autonomic nervous system diseases 



Autonomic nervous system


Blood pressure


Chronic orthostatic intolerance




Forearm vascular resistance


Heart rate


Head-up tilt




Cell membrane norepinephrine transporter


Neurally mediated hypotension


Neurogenic orthostatic hypotension


Orthostatic hypotension


Postural tachycardia syndrome


Sympathetic noradrenergic system


Cardiac stroke volume


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyMayo ClinicJacksonvilleUSA
  2. 2.Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural ResearchNational Institute of Neurological, Disorders and Stroke, National Institutes of HealthBethesdaUSA

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