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

Udyavar, AmeyaShenthar, JayaprakashNaik, Ajay MadhukarKhanra, DibbendhuRamalingam, VadiveluSinghal, RahulChoudhary, DineshGupta, Prabha NiniRao, B HygrivMehrotra, SaurabhArora, VanitaKathuria, SanjeevSuri, PawanBenditt, DavidSutton, Richard2025-08-132025-08-132025-06Udyavar Ameya, Shenthar Jayaprakash, Naik Ajay Madhukar, Khanra Dibbendhu, Ramalingam Vadivelu, Singhal Rahul, Choudhary Dinesh, Gupta Prabha Nini, Rao B Hygriv, Mehrotra Saurabh, Arora Vanita, Kathuria Sanjeev, Suri Pawan, Benditt David, Sutton Richard . A contemporary review of the head-up tilt test: Utility and limitations. Indian Heart Journal. 2025 Jun; 77(3): 243-2510019-4832https://imsear.searo.who.int/handle/123456789/253346The 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.Head-up tilt testSyncopeVasovagal syncopeOrthostatic hypotensionPsychogenic pseudosyncopeA contemporary review of the head-up tilt test: Utility and limitationsJournal ArticleIndiaP.D. Hinduja National Hospital, Mahim, Mumbai, IndiaSri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, IndiaArrhythmia and Heart Failure Device Division, Marengo CIMS Hospital, IndiaQueen Elizabeth Hospital, Birmingham, United KingdomDepartment of Cardiology, Velammal Medical College Hospital, Madurai, IndiaCardiology and Cardiac Electrophysiology, Fortis Hospital, Jaipur, IndiaCardiology, S P Medical College, Bikaner, Rajasthan, IndiaSri Ramakrishna Mission Hospital Trivandrum, IndiaDivision of Pacing &Electrophysiology, KIMS Hospitals, Hyderabad, IndiaCardiology, PGIMER, Chandigarh, IndiaCardiac Electrophysiologist, Indraprastha Apollo Hospital, New Delhi, IndiaGIPMER, New Delhi, IndiaGlobal Hospital, Jalandhar, Punjab, IndiaArrhythmia Service, Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USADept. of Cardiology, National Heart & Lung Institute, Hammersmith Hospital Campus, Imperial College, London, United Kingdom