A contemporary review of the head-up tilt test: Utility and limitations

Ameya Udyavar; Jayaprakash Shenthar; Ajay Madhukar Naik; Dibbendhu Khanra; Vadivelu Ramalingam; Rahul Singhal; Dinesh Choudhary; Prabha Nini Gupta; B. Hygriv Rao; Saurabh Mehrotra; Vanita Arora; Sanjeev Kathuria; Pawan Suri; David Benditt; Richard Sutton

doi:10.1016/j.ihj.2025.03.014

A contemporary review of the head-up tilt test: Utility and limitations

Ameya Udyavar, Jayaprakash Shenthar, Ajay Madhukar Naik, Dibbendhu Khanra, Vadivelu Ramalingam, Rahul Singhal, Dinesh Choudhary, Prabha Nini Gupta, B. Hygriv Rao, Saurabh Mehrotra, Vanita Arora, Sanjeev Kathuria, Pawan Suri, David Benditt, Richard Sutton

Medicine - Cardiology Division

Research output: Contribution to journal › Review article › peer-review

Abstract

The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT's utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.

Original language	English (US)
Journal	Indian heart journal
DOIs	https://doi.org/10.1016/j.ihj.2025.03.014
State	Accepted/In press - 2025

Bibliographical note

Publisher Copyright:
© 2025 Cardiological Society of India

Keywords

Head-up tilt test
Orthostatic hypotension
Psychogenic pseudosyncope
Syncope
Vasovagal syncope

PubMed: MeSH publication types

Journal Article
Review

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10.1016/j.ihj.2025.03.014License: CC BY

Cite this

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title = "A contemporary review of the head-up tilt test: Utility and limitations",

abstract = "The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT's utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.",

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author = "Ameya Udyavar and Jayaprakash Shenthar and Naik, {Ajay Madhukar} and Dibbendhu Khanra and Vadivelu Ramalingam and Rahul Singhal and Dinesh Choudhary and Gupta, {Prabha Nini} and Rao, {B. Hygriv} and Saurabh Mehrotra and Vanita Arora and Sanjeev Kathuria and Pawan Suri and David Benditt and Richard Sutton",

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year = "2025",

doi = "10.1016/j.ihj.2025.03.014",

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journal = "Indian heart journal",

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AU - Udyavar, Ameya

AU - Shenthar, Jayaprakash

AU - Naik, Ajay Madhukar

AU - Khanra, Dibbendhu

AU - Ramalingam, Vadivelu

AU - Singhal, Rahul

AU - Choudhary, Dinesh

AU - Gupta, Prabha Nini

AU - Rao, B. Hygriv

AU - Mehrotra, Saurabh

AU - Arora, Vanita

AU - Kathuria, Sanjeev

AU - Suri, Pawan

AU - Benditt, David

AU - Sutton, Richard

PY - 2025

Y1 - 2025

N2 - The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT's utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.

AB - The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT's utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.

KW - Head-up tilt test

KW - Orthostatic hypotension

KW - Psychogenic pseudosyncope

KW - Syncope

KW - Vasovagal syncope

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JO - Indian heart journal

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ER -

A contemporary review of the head-up tilt test: Utility and limitations

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

Publisher link

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