Autonomic Nervous System Testing (ANS)
The Autonomic nervous system (ANS) regulates physiological processes, such as blood pressure, heart rate, body temperature, digestion, metabolism, fluid, electrolyte balance, sweating, urination, defecation, and sexual response. Regulation occurs without conscious control, i.e., autonomously. The ANS has two major divisions: the sympathetic and parasympathetic systems. Many organs are controlled primarily by the sympathetic or parasympathetic system, although they may receive input from both; occasionally, functions are reciprocal (e.g., sympathetic intake increases heart rate; parasympathetic decreases it).
The sympathetic nervous system is catabolic and activates fight-or-flight responses. Thus, sympathetic output increases heart rate and contractility, bronchodilation, hepatic glycogenolysis and glucose release, BMR (basal metabolism rate), and muscular strength; it also causes sweaty palms. In addition, more minor immediately-life-preserving functions (e.g., digestion, renal filtration) are decreased.
The parasympathetic nervous system is anabolic; it conserves and restores. As a result, gastrointestinal secretions and motility (including evacuation) are stimulated, slowed heart rate, and blood pressure decreases.
Disorders of the ANS can affect any system of the body; they can originate in the peripheral or central nervous system and may be primary or secondary to other disorders. Symptoms suggesting autonomic dysfunction include orthostatic hypotension, heat intolerance, nausea, constipation, urinary retention or incontinence, nocturia, impotence, and dry mucous membranes. If a patient has symptoms suggesting autonomic dysfunction, cardiovagal, adrenergic, and sudomotor tests are usually done to help determine the severity and distribution of the dysfunction.
Autonomic Regulation is the body's ability to maintain homeostasis (stability and balance) during internal and external stimuli. Autonomic Regulation is always functioning, and we are often unaware of the crucial tasks. When the nerves that control Autonomic Regulation are damaged, Autonomic Dysfunction can develop. Autonomic Dysfunction can be temporary or chronic. Diabetes and Parkinson's disease are two examples of chronic conditions that can lead to Autonomic Dysfunction. VitalScan ANS+ tests Autonomic Regulation through a combination of Heart Rate Variability (HRV) Assessment and Cardiac Autonomic Reflex Tests (CARTs).
Cardiovagal innervation testing evaluates heart rate response to deep breathing and the Valsalva maneuver via electrocardiogram rhythm strip. If the ANS is intact, heart rate varies with these maneuvers; the Valsalva ratio of longest to shortest HR should be 1.4 or greater.
Vasomotor adrenergic innervation testing evaluates the response of beat-to-beat blood pressure to the head-up tilt and Valsalva maneuver. The head-up tilt shifts blood to dependent parts, causing reflex responses. The Valsalva maneuver increases intrathoracic pressure and reduces venous return, causing blood pressure changes and reflex vasoconstriction. In both tests, the pattern of responses is an index of adrenergic function.
Autonomic nervous system (ANS) testing, including parasympathetic function (cardiovagal innervation) and sympathetic adrenergic function (vasomotor adrenergic innervation) assessment.
VitalScan ANS+ is a diagnostic tool to evaluate symptoms of vasomotor instability for any of the following:
- Diagnose the presence of autonomic neuropathy in a patient with symptoms suggesting a progressive autonomic neuropathy, including Diabetic neuropathy, Amyloid neuropathy, Sjogren's syndrome, Idiopathic neuropathy, Pure autonomic failure, and Multiple system dystrophy.
- Evaluate the severity and distribution of a diagnosed progressive autonomic neuropathy
- Differentiate the diagnosis between certain variants of syncope from other causes of loss of consciousness
- Evaluate inadequate response to beta blockade in vasodepressor syncope
- Differentiate the cause of postural tachycardia syndrome
- Evaluate change in type, distribution or severity of autonomic deficits in patients with autonomic failure
- Evaluate the response to treatment in patients with autonomic failure
- Diagnose axonal neuropathy or suspected autonomic neuropathy in the symptomatic patient
- Evaluate and diagnose sympathetically maintained pain, as in reflex sympathetic dystrophy or causalgia
- Evaluate and treat patients with recurrent unexplained syncope to demonstrate autonomic failure
Heart Rate Variability (HRV) is a measure of the variation in beat-to-beat intervals in heart rate. Heart rate variability analysis is a powerful tool in assessment of the autonomic function. It is accurate and reliable, yet simple to measure (i.e. noninvasive) and quick to process.
ANS analysis measures neuro-cardiac function which reflects heart-brain interactions and autonomic nervous system dynamics. The autonomic nervous system is involved in the function of virtually every organ system and clinical manifestations of autonomic dysfunction are involved in just about every disease. As a result, ANS analysis is used as a screening and monitoring tool in many disease processes.
Higher variations in the heart rate lead to greater heart rate variability which indicates good health and well-balanced autonomic function (sympathetic and parasympathetic nervous systems). In contrast, steadier heart rate leads to lower heart rate variability which indicates an imbalance in the autonomic function and implies the presence of physiological malfunction.
VitalScan ANS+ delivers laboratory analyses to the physician's office, enabling professionals to assess patient health conveniently and reliably. Applications include:
- Verifying the effectiveness of treatment and intervention
- Monitoring overall patient health
- Screening the general population
- Identifying various health issues such as heart palpitations, pain management, sleep apnea, anxiety, stress, psychological disorders, asthma, and neurological conditions
- Examining for Cardiac Autonomic Neuropathy (CAN) and Diabetes Autonomic Neuropathy (DAN)
- Measuring the Sympathetic Nervous System's predominance in cases such as Metabolic Syndrome, Hypertension or Heart Failure
- Screening for unfavorable in the absence of clinically apparent health situations
Significant Clinical Applications
VitalScan ANS+ assessments provide supplemental monitoring and optimized detection of cardiovascular, neurological, and metabolic conditions associated with many adverse health events. The VitalScan ANS+ product range offers physicians and health professionals convenient, cost-effective solutions for clinical testing and optimized patient assessment.
Applications include the following:
Autonomic Function Assessment has acquired exceptional popularity over the last few years. Nowadays, the main stream medical associations around the world accept ANS studies as one of the best predictors of specific and non-specific health risk. Scientific and Clinical studies have established its usefulness in almost all branches of medicine.
How It Helps Patients:
- Evaluation of current health situation - symptoms, medications and therapy reactions
- Assessment of possible adequacy of the recovery process
- Initiation of Physician's focus to treat the onset of chronic situations or severity of the diseases
- Evaluation of the prognosis and treatment outcomes
- Identification of abnormalities in cardiovascular, cerebrovascular system and overall health assessment
- Blood circulatory status - age of blood vessels based on arterial elasticity, peripheral circulatory rate, organic/functional abnormality of the blood vessels
- Prediction and progression of Arteriosclerosis, Obesity, Hypertension, Hyperlipidemia and Diabetes
- Useful as a health barometer;
How It Helps Clinicians:
- Monitoring current health of the individual patient closely
- Verifying the efficacy of current treatment protocol and intervention
- Examining patients for Cardiac Autonomic Neuropathy (CAN) and Diabetes Autonomic Neuropathy (DAN)
- Measuring the Metabolic Syndrome, Hypertension, Heart Failure
- Predicting burn-out syndrome, anxiety, depression, psychological conditions
- Exploring Asthma, COPD, Palpitations, Pain management, Sleep apnea
- Optimization of treatment for each individual patient
- Immediate reports - qualitative, quantitative and graphic analysis and results of ANS balance, cardiovascular, stress, fitness and overall health assessment
- Comparisons with a patient case history and necessary procedural actions
- Efficient patient-centered multiple symptoms treatment management
Heart Rate Variability (HRV) is a physiological function whereby the time interval between heart beats varies. These variations in heart rate reflect the quality of cardiovascular autonomic function. Autonomic function or function of the autonomic/visceral nervous system regulates involuntary action (eg. respiration, digestion) of the intestines, heart, smooth muscle, and glands. This function is divided into two physiologically and anatomically distinct, mutually antagonistic subsystems: the sympathetic nervous system and the parasympathetic nervous system.
VitalScan ANS+ systems provide Autonomic Function testing which enable physicians to monitor the activity of both the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) in order to accurately assess the state of a patient's autonomic function.
VitalScan ANS+ provides a two-pronged approach to patient evaluation. Firstly, VitalScan ANS+ is able to detect specific types of autonomic dysfunction which can consequently be linked to a multitude of clinical diagnoses. Secondly, VitalScan ANS+ can be utilized for thorough, comprehensive assessments and physiological monitoring which provide physicians with a detailed and thorough patient appraisal which can often be overlooked in standard evaluations.
The wide range of clinical applications for VitalScan ANS+ makes it principally different from all other classes of diagnostic devices. VitalScan ANS+ allows the physician to thoroughly investigate modalities:
- Assessment of resting autonomic balance
- Assessment of reaction of the ANS on orthostatic intervention
- Assessment of autonomic reaction during Valsalva maneuver and deep breathing
- Sympathetic and Parasympathetic autonomic balance correction
The significance of the VitalScan ANS+ method in the development of ANS assessment:
In the past, autonomic function could only be approximately assessed by the following three parameters: Autonomic Balance (Vegetative Homeostasis), Sympathetic Prevalence, Parasympathetic Prevalence. The criteria used for evaluating these parameters were clinical and laboratory findings therefore assessment of the autonomic function was labor intensive and not always feasible.
The introduction of HRV analysis revolutionized ANS assessment and opened new doors for its theoretical application. Making practical use of this important scientific discovery, however, required deriving a quantitative relationship between SNS and PSNS from the spectral function.
HRV analysis is based upon measuring variability in heart rate; specifically, variability in intervals between R waves - "RR intervals". These RR intervals are then analyzed by spectral (as in VitalScan ANS+) or some other form of mathematical analysis. Such mathematical analysis generates multiple parameters; time domain and frequency domain. The problem of SNS-PSNS quantification is in reducing all possible variations of these multiple parameters to a quantitative relationship between the SNS and PSNS. For many years, this issue has been the central obstacle in HRV analysis.
VitalScan ANS+ is the first and only system to solve the problem of SNS-PSNS quantification. This technological breakthrough is achieved by using proprietary algorithms and a pioneering approach. The algorithms used by VitalScan ANS+ have been developed and tested exhaustively for over 40 years. Studies of efficacy and accuracy have involved over 500,000 patients to ensure success.
The result of this in depth research is objective and reliable evaluations of ANS state during rest, during Orthostatic (seated-to-standing) testing and during the Valsalva maneuver combined with deep breathing. VitalScan ANS+ analyses are far-reaching and highly sophisticated. Consequently, VitalScan ANS+ is the only method that enables precise recognition and classification of up to 100 ANS states while providing corresponding descriptions of each.
Until the development of the VitalScan ANS+ method, there was no practical means of assessing ANS independently outside of a research laboratory. VitalScan ANS+ brought laboratory analyses into the physician's office and became the first and only system to provide a quantitative interpretation of HRV spectral function as well as a qualitative analysis of the resulting parameters.
The goal and achievement of the VitalScan ANS+ research team is in providing physicians worldwide with a reliable office device capable of multiple clinical applications including the assessment of risk in cardiovascular diseases, objective assessment of benefit for cardiac and orthopedic intervention, and the quantification of drug effect on the autonomic function.