“It’s like torture”: The tilt table test could be risky for many people with Long COVID

[Mij]

The Sick Times: https://thesicktimes.org/2025/04/08...uld-be-risky-for-many-people-with-long-covid/

Key points you should know:

• The tilt table test (TTT), commonly given to diagnose postural orthostatic tachycardia syndrome (POTS), can be dangerous for some people with Long COVID, especially those who experience PEM.
  

• It is well-known that the TTT can provoke fainting and even a temporarily stopped heart, but the medical literature doesn’t reflect how many patients can experience debilitating PEM after the exam.
  

• Alternative tests, including the NASA lean test and active stand test, are becoming more commonly used because of their safety and accessibility, though there are debates about whether they are as reliable as the TTT.
  

• Clinicians also debate whether the POTS diagnostic criteria are too strict in terms of determining who should be treated.
  

• For patients who have no choice but to have a TTT, there are methods for mitigating the possible harm, including saline infusions and ample rest and recovery before and after.

 

[EndME]

I am aware that there is currently no evidence that suggests that saline infusions do anything in the context of ME/CFS (current trial ongoing by the OMF), but why would somebody think that it would reduce the impact of a TTT on PEM after the TTT has taken place? Is there any logic in that argument?

 

[Utsikt]

There is a discussion about an opinion piece that argues against the TTT here:https://www.s4me.info/threads/aboli...-workup-of-syncope-2020-kulkarni-et-al.42751/

 

[Utsikt]

I am aware that there is currently no evidence that suggests that saline infusions do anything in the context of ME/CFS (current trial ongoing by the OMF), but why would somebody think that it would reduce the impact of a TTT on PEM after the TTT has taken place? Is there any logic in that argument?

No idea.

It’s a claim by Rowe:

Rowe suggests that people ask for a saline infusion after the exam. When he uses a TTT — which he only does for research — he gives each patient a liter or two of saline to prevent PEM. “They often leave feeling better than when they came in after the IV fluids,” he said.

 

[Mij]

I have never been tested for POTS, but I do have OI, and drinking salty broth helps with delayed PEM the next day.

The saltiness helps retain fluids because I always feel dehydrated during delayed PEM.

 

[ahimsa]

I am aware that there is currently no evidence that suggests that saline infusions do anything in the context of ME/CFS (current trial ongoing by the OMF), but why would somebody think that it would reduce the impact of a TTT on PEM after the TTT has taken place? Is there any logic in that argument?

I don't know the reason behind using a saline IV after a tilt table test (head up tilt) but I'll share a personal experience.

After I passed out on my first tilt table test (January 1995) they gave me a saline infusion. I'm in Oregon, and the hospital that did my tilt table test has no relation to Dr. Rowe. I'm guessing it must be a treatment that was generally thought (at least back then) to help people after they have fainted?

EDIT: I did some searching (saline IV and a few other keywords) and stumbled on this interesting article comparing saline with lactated Ringer's solution:

https://www.npr.org/sections/health...rile-salt-water-become-the-iv-fluid-of-choice