Typically, a battery of specific tests is selected to meet the objectives defined by the referring physician. This battery is defined by autonomic function can be either cardiovagal, adrenergic, or sudomotor, peripheral or cerebral blood flow evaluation. Testing is safe and presents only minimal discomfort for the patient, while at the same time providing valuable information for the clinician.

ØQUANTITATIVE  SUDOMOTOR AXON REFLEX TESTING (QSART)

QSART offers quantitative measurement of axon reflex-mediated sudomotor (sweat) responses and the evaluation of postganglionic sympathetic small nerve fibers. Measurements are taken at four skin sites on the upper and lower extremities.

ØRESTING SWEAT TESTING

This test measures the amount of sweat produced while the body is at rest as another index of activity of small nerve fibers. During testing, the patient lies quietly and is usually very comfortable.

ØVASOMOTOR TESTING

Skin temperatures at various sites on the arms and legs is recorded using a highly sensitive thermometer.

ØEVALUATION OF CARDIAC-VAGAL AND ADRENERGIC FUNCTIONS

The following tests are conducted to measure beat-to-beat blood pressure, heart rate respiration, carbon dioxide in response to various stimuli.

ØDEEP BREATHING

This is one of the most reliable cardiovascular heart rate tests for evaluating autonomic function and measures heart rate responses to deep slow breathing.

ØVALSALVA MANEUVER

This test mimics everyday activities which require heavy lifting or straining, that may result in lightheadedness or even loss of consciousness.   During the Valsalva maneuver, the patient is asked to exhale steadily into a bugle for 15 seconds at 40 mmHg while in the supine position.

ØTILT TABLE TEST

Current standardized tilt protocols possess the sensitivity and specificity to identify individuals with pre-syncope, syncope, and orthostatic hypotension.   Tilt table testing evaluates beat-to-beat heart rate and blood pressure, respiration and carbon dioxide responses to passive standing.

ØQUANTITATIVE SENSORY TESTING

Quantitative sensory testing evaluates sensation of vibration, cold, warm, heat, and pain. It can be used for the patients with chronic pain.

ØELECTROENCEPHALOGRAPHIC MONITORING (EEG)

Simultaneous EEG  (brain activity) and cardiovascular monitoring can be ordered for differentiation of seizures vs syncope.

ØTRANSCRANIAL DOPPLER MONITORING (TCD)

TCD enables noninvasive monitoring of cerebral blood flow from intracranial vessels for evaluation of vasospasm, stroke and migraine headache.

ØDUPLEX IMAGING

Ø24-HOUR AMBULATORY BLOOD PRESSURE MONITORING

Enables noninvasive ambulatory monitoring of blood pressure over the period of 24 hours.