Long COVID Atlas
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Note

Education, not medical advice. Tests and their interpretation belong with your own clinician.

Diagnostic · Autonomic

Head-up tilt-table test

The standard way to catch what standing does to a struggling circulation, under controlled conditions. The tilt-table test raises a person upright while tracking heart rate and blood pressure, documenting POTS, orthostatic intolerance, or fainting that a seated exam cannot.

Short version: the tilt-table test provokes and records the body's response to being upright, confirming POTS or orthostatic intolerance. A simple stand test often comes first.

A controlled way to provoke the problem

The head-up tilt-table test straps a person to a table that tilts them upright while heart rate and blood pressure are recorded continuously. It reproduces, in a controlled way, what standing does to a struggling circulation, the trigger behind POTS and orthostatic intolerance.1

What standing up does Lying downheart rate about 72,blood spread evenly stand up Standingblood pools in the legs;to compensate the heartraces 30+ beats faster POTS = the racing heart on standing;orthostatic intolerance = dizzy, foggy, faint upright
Standing is a small cardiovascular stress test. Gravity pulls blood into the legs, and the body must tighten vessels and adjust heart rate to keep the brain supplied. When that reflex misfires, the heart compensates by racing (POTS) and the brain is briefly under-supplied, felt as dizziness, lightheadedness, and fog on standing.

What it shows

It can document the sustained heart-rate rise that defines POTS, blood-pressure falls that point to other forms of orthostatic intolerance, or fainting patterns, distinguishing causes that look similar at the bedside.1

reference test

Tilt versus a simple stand test

A simple active-stand test captures much of the same information without equipment and is often the practical first step. Tilt testing adds value for unclear cases or fainting, but can itself provoke symptoms.

What we don't know

Honest about the edges of the evidence. These are open questions, not settled answers.

  • When tilt adds value over a simple stand test.
  • How to limit symptom provocation during the test.
  • How results should guide treatment choice.

References

Every reference is free to read in full.

  1. Autonomic testing including head-up tilt in post-COVID dysautonomia.