Cardiology · London
Tilt table test - private in London.
A consultant-supervised assessment for unexplained blackouts, vasovagal syncope and postural tachycardia syndrome. Same-week booking across the Harley Street syncope units. £550-£950 all-inclusive.
What it is
A positional stress test for the autonomic nervous system.
The tilt table test measures how your heart rate and blood pressure respond to a sustained change in posture. By holding you at 60-70 degrees head-up on a motorised table, the test provokes and captures the reflex faint or postural tachycardia that has been happening in daily life.
Beat-to-beat monitoring
Continuous ECG and non-invasive finger-cuff blood pressure record every heartbeat and every pressure swing. Nothing is averaged out.
Reproduces your symptoms
The point is not just to see a number change - it is to reproduce the lightheaded, greying-out or blackout episode under monitoring, so the mechanism is captured.
Rules cardiac syncope in or out
Used alongside ECG, Holter and echocardiogram, tilt testing helps separate reflex faints from dangerous arrhythmic or structural causes.
Who it is for
Referred when the story fits, and the ECG does not answer it.
Most patients arrive after a first-line workup - resting ECG, 24-hour Holter, blood tests and an echo - has been unrevealing.
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Unexplained syncope
Recurrent blackouts where the ECG, Holter and echocardiogram have not given an answer.
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Suspected vasovagal syncope
Situational faints triggered by standing, heat, pain or emotional stress.
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PoTS diagnosis
Postural tachycardia with lightheadedness, palpitations or brain fog on standing.
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Orthostatic intolerance
Persistent dizziness, fatigue or presyncope when upright, often in younger adults.
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Differential from cardiac syncope
To confirm a reflex cause once structural heart disease and arrhythmia have been excluded.
How the test runs
From lying flat to the diagnostic moment.
Plan on around 90 minutes at the clinic. You are supervised throughout by a consultant cardiologist and a specialist physiologist.
- 01
Before
Referral and history review
A brief consultation with the supervising cardiologist. Blackout diary, medication list, ECG and any Holter data reviewed in advance.
- 02
Before
Preparation and fasting
Fast for 4 hours if the provocation phase is planned. Hold hypotensive medications only if specifically instructed.
- 03
On the day
Baseline supine phase
Lie flat on the tilt table for 10-15 minutes. Continuous ECG and non-invasive beat-to-beat blood pressure applied.
- 04
On the day
Head-up tilt (passive)
Table tilted to 60-70 degrees. You stand supported for 30-45 minutes while heart rate and blood pressure are tracked.
- 05
On the day
Optional provocation
If the passive phase is negative, sublingual GTN or intravenous isoprenaline may be given to unmask a susceptible response.
- 06
On the day
Recovery and debrief
Table returned flat. A short recovery period, tea and biscuits, and a same-day verbal summary from the cardiologist.
- 07
After
Full report and plan
A written consultant report within 3-5 working days, with a management plan sent to your GP or referring specialist.
How to prepare
Simple, but a few things matter.
Preparation instructions are confirmed by the clinic 48 hours before the appointment.
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Fast for 4 hours
From food and dairy if the provocation phase is planned. Clear water is fine and encouraged.
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Medication review
Continue most medications as normal. Hold beta blockers, midodrine or fludrocortisone only if the cardiologist has specifically asked.
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Comfortable clothes
Loose top with easy sleeve access for the blood pressure cuff and ECG leads. Flat shoes.
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Companion for the journey home
Because you may faint on the day, do not drive yourself. Bring someone, or plan a taxi.
What a positive test looks like
The patterns your cardiologist is looking for.
Each pattern points to a different management route.
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Vasovagal response
A sudden drop in blood pressure and/or heart rate reproducing your symptoms. Classified as vasodepressor, cardio-inhibitory or mixed.
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PoTS pattern
A sustained rise in heart rate of more than 30 bpm (or above 120 bpm) within 10 minutes of tilt, without a significant BP drop.
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Orthostatic hypotension
A drop of 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of head-up tilt.
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Dysautonomic pattern
A gradual, progressive fall in blood pressure suggesting autonomic failure. Warrants neurology review.
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Negative test
Blood pressure and heart rate remain stable throughout. Reflex syncope is unlikely and other causes are explored.
Cost in London
All-inclusive private pricing.
Every quoted price includes the consultant cardiologist supervising the test, the physiologist, the equipment, and the written report.
| Test | Indicative price | Duration | Report turnaround |
|---|---|---|---|
| Tilt table test (passive protocol) | £550-£750 | 60-75 min | 3-5 days |
| Tilt table test with GTN provocation | £650-£850 | 75-90 min | 3-5 days |
| Tilt table test with isoprenaline provocation | £750-£950 | 90 min | 3-5 days |
| Combined tilt + active stand + Valsalva autonomic screen | £850-£1,200 | 90-120 min | 5-7 days |
| Follow-up cardiology consultation to discuss findings | £220-£350 | 30 min | Same day |
Insurer-funded tests are pre-authorised before booking. Self-pay quotes are firm, with no add-on charges on the day.
Where it is done
The London syncope units we work with.
Choice of clinic is driven by proximity, the consultant best suited to your case, and insurer recognition.
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HCA, SE1
London Bridge Hospital
Full syncope service with beat-to-beat monitoring and same-day cardiology review.
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HCA, NW8
HCA The Wellington Hospital
Established tilt lab with GTN and isoprenaline protocols.
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W1
One Welbeck Heart Health
Consultant-led electrophysiology unit, PoTS pathway and combined autonomic testing.
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WC1
National Hospital for Neurology (Private)
Queen Square autonomic unit for complex dysautonomia and neurogenic syncope.
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SW3
Royal Brompton (Private Practice)
Cardiology-led tilt testing with rapid access to structural imaging if needed.
What happens next
A stepped approach - lifestyle first, drugs later, pacing rarely.
Most reflex syncope and PoTS respond well to non-drug measures. Medication and pacing are reserved for stubborn or high-risk patterns.
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Lifestyle and self-management
Hydration to 2-3 litres a day, liberal salt intake, avoiding known triggers, and rising slowly from lying or sitting.
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Physical counter-manoeuvres
Leg crossing, buttock clenching, arm tensing and squatting can abort a warning of an impending faint.
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Compression garments
Waist-high 30-40 mmHg compression stockings improve venous return and reduce PoTS symptoms in many patients.
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Medication for PoTS
Midodrine, fludrocortisone, low-dose beta blockers or ivabradine, selected to the phenotype and comorbidities.
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Cardiac pacing
Rarely, a dual-chamber pacemaker is offered for severe, recurrent cardio-inhibitory syncope with documented long asystolic pauses.
Related
Tests and conditions often paired with tilt testing.
Where the tilt result points to a heart-rhythm cause, or a broader autonomic problem, the next test is usually one of these.
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24-hour Holter monitor
Continuous ECG to catch arrhythmias missed on a resting trace.
Read more -
Echocardiogram
Ultrasound of the heart to rule out structural causes of syncope.
Read more -
Atrial fibrillation
The commonest arrhythmia to consider before labelling syncope reflex.
Read more -
Insomnia
Poor sleep can amplify PoTS and vasovagal symptoms.
Read more
Frequently asked
Everything we get asked before booking a tilt test.
Quick answers on safety, fasting, results and insurance.
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Will I actually faint during the test?
Sometimes, yes - that is part of the test. The table is padded and you are strapped in, monitored throughout, and returned flat within seconds if you lose consciousness. Reproducing your symptoms is what makes the diagnosis, so a controlled faint is a useful result.
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Do I need to fast beforehand?
Fast from food and dairy for 4 hours before the appointment if the provocation phase is planned. Clear water is encouraged. If only the passive protocol is booked, a light meal 2 hours before is fine.
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Is the GTN or isoprenaline provocation safe?
Yes. Both are given at low doses in a monitored setting by a consultant cardiologist, with resuscitation equipment on hand. Side effects are usually short-lived: a headache from GTN, or brief palpitations from isoprenaline.
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How long until I get the results?
You will get a verbal summary the same day. The full written consultant report, with a management plan, is issued within 3-5 working days and copied to your GP or referring specialist.
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Will my private insurance cover this?
Most policies cover a tilt table test when it is medically indicated and pre-authorised. Bupa, AXA Health, Vitality, Aviva, WPA, Cigna and Healix are all recognised. We handle pre-authorisation before booking.
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How often should the test be repeated?
It is rarely repeated. Once a reflex pattern or PoTS is confirmed, follow-up is clinical: symptom diaries, response to treatment and occasional Holter or standing tests. Repeat tilt testing is only considered if the picture changes substantially.
Ready when you are
Blackouts, lightheadedness or a suspected PoTS diagnosis?
Send us a short note about your symptoms and any tests already done. We come back within one working day with a suggested consultant, clinic and firm price.