Name of the Procedure:

Testing of Autonomic Nervous System Function; Vasomotor Adrenergic Innervation (Sympathetic Adrenergic Function), including Beat-to-Beat Blood Pressure and R-R Interval Changes during Valsalva Maneuver and at Least 5 Minutes of Passive Tilt

Summary

This procedure evaluates the function of the autonomic nervous system by monitoring your heart rate and blood pressure response to the Valsalva maneuver (a specific breathing technique) and a passive tilt (being tilted on a table). It helps detect issues with your body's ability to regulate blood pressure and heart rate.

Purpose

The test aims to identify abnormalities in the sympathetic adrenergic function of the autonomic nervous system, which is crucial for regulating blood pressure and heart rate. The information gathered can help diagnose conditions like dysautonomia, orthostatic hypotension, or other autonomic disorders, ensuring appropriate treatment and management.

Indications

• Unexplained fainting or syncope
• Suspected autonomic dysfunction
• Conditions like postural orthostatic tachycardia syndrome (POTS)
• Chronic fatigue syndrome
• Diabetes with neuropathy affecting the autonomic nervous system

Preparation

• Patients may need to fast for a few hours before the test.
• Certain medications might need to be adjusted or paused.
• Baseline diagnostic tests like blood pressure and heart rate measurements could be required.

Procedure Description

1. The patient lies down on the examination table.
2. Electrodes are placed to monitor heart rate (R-R interval) and beat-to-beat blood pressure.
3. During the Valsalva maneuver, the patient exhales forcefully into a device while heart rate and blood pressure responses are measured.
4. The patient then undergoes a passive tilt, where the table is tilted to a 70-degree angle for at least 5 minutes, observing the body's cardiovascular responses.
5. Data is collected and analyzed to assess autonomic function.

No anesthesia or sedation is needed for this non-invasive procedure.

Duration

The complete procedure typically lasts about 30 to 45 minutes.

Setting

This test is performed in a hospital or outpatient clinic, often in a specialized autonomic testing or cardiology unit.

Personnel

• Physician (usually a neurologist or cardiologist)
• Nurse or medical technician

Risks and Complications

• Rarely, the patient might experience dizziness or fainting during the test.
• Minor discomfort from the Valsalva maneuver.
• Potential for allergic reactions to electrode adhesives (very uncommon).

Benefits

• Provides crucial information for diagnosing autonomic nervous system disorders.
• Helps tailor effective treatment plans.
• Non-invasive with minimal discomfort.

Recovery

• Patients can usually resume normal activities immediately after the test.
• No special post-procedure care is necessary.
• Follow-up appointments may be scheduled to discuss test results.

Alternatives

• 24-hour heart rate and blood pressure monitoring.
• Tilt table testing without continuous beat-to-beat monitoring.
• Laboratory-based adrenergic function tests.
• Each alternative has its own benefits and limitations compared to this detailed autonomic function test.

Patient Experience

During the procedure, patients might feel some discomfort while performing the Valsalva maneuver and slight dizziness during the tilt phase. It's usually well-tolerated, and staff are present to ensure patient comfort and safety.