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Autonomic Function Assessments


Primary Care, Cardiology, Pulmonology, Endocrinology, Neurology, Pain Management

TopDoc DX ANS+

Autonomic Nervous System (ANS) Testing provides comprehensive, fully automated autonomic testing equipment that is useful for physicians to gauge their patient's health and uncover hidden disease.

Testing the autonomic nervous system can identify clinical autonomic disorders uncover major illness and other hidden diseases, such as:


  • Sudden Death

  • Silent Heart Attack

  • Hypertension

  • Syncope

  • Vascular Abnormalities

  • Cardiac Autonomic Neuropathy (CAN)

  • Orthostatic Hypotension

  • Orthostatic Tachycardia Syndrome (POTS)


Physician Benefits

TopDocDX ANS+ is a valuable tool in diagnosing hidden illnesses. Having the ability to quickly and easily test patients, and receive immediate comprehensive interpretive reports after the test is invaluable to medical practitioners.
Testing takes only 15 minutes to run. Full battery of tests interpretive reports are generated immediately after testing. The reports are very easy to read and understand by the physician.
TopDocDX ANS+ has 39 standardized tests. In addition, provides with the ability to customize testing protocols and create custom templates.

Why Test ANS?

  • "According to Published Studies "Cardiovascular autonomic neuropathy occurs in about 17% of patients with type 1 diabetes and 22% of those with type 2"

  • "Of patients with symptomatic autonomic dysfunction, 25% to 50% die within 1 to 5 years of diagnosis."

  • "A patient's history and physical examination are ineffective for early detection of CAN, and therefore noninvasive tests that have demonstrated efficacy are required".

  • "Screening for Autonomic Neuropathy should be instituted at Diagnosis of Type 2 Diabetes and 5 years after the diagnosis of type 1 Diabetes - 2005 ADA Standard of Diabetes Care"

  • "Although it can cause severe cardiovascular problems and sudden death, surveys show that only 2% of people with diabetes are tested for cardiovascular autonomic neuropathy (CAN)".

Features and Benefits

  • Easily adaptable towards general and specific requirements of almost all medical branches.

  • Presents a quick and reliable supplementary assessment of basic health risk factors. Assesses the balance between the activities of the sympathetic and parasympathetic branches of the autonomic nervous system.

  • Reliably discovers ventricular and supraventricular extrasystoles.

  • Assesses autonomic physical dysregulation, accumulated physical and mental stress.

  • Assesses physical training needs based upon an individual's personal cardiovascular fitness levels.

  • Reveals development of possible health risks.

  • Provides early indications of health risks for quick detection and prevention of illness, disease, and progressive stress conditions before onset and development.

  • Efficiently screen mass population to detect potential risks and reserve costly, full medical checkups for only those exhibiting health threats.


Significant Clinical Applications

TopDocDX ANS+ is 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, 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; or

  • Evaluate and treat patients with recurrent unexplained syncope to demonstrate autonomic failure.


TopDocDX ANS+ assessments provide supplemental monitoring and optimized detection of cardiovascular, neurological and metabolic conditions associated with a multitude of adverse health events. TopDocDX ANS+ product range provide physicians and health professionals with convenient, cost-effective solutions for clinical testing and optimized patient assessment.
Applications include the following:

  • Beta-Blocker Responsiveness

  • Cardiovascular Autonomic Neuropathy (CAN)

  • Diabetic Autonomic Neuropathy (DAN)

  • Cardiomyopathies

  • Cardiac Arrhythmias

  • Congestive Heart Failure

  • Syncope

  • Hypertension

  • Sleep Apnea

  • Asthma

  • Sudden Death

  • COPD

  • Peripheral Vascular Diseases

  • Orthostatic Hypotension

  • Circulation Problems

  • Pain Management

  • Neurological Conditions

  • Chronic Regional Pain Syndrome

  • Anxiety/Stress

  • Parkinson's Disease

  • Psychological Conditions

  • Other Hidden Diseases

How It Helps Your 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 status, 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 You:

  • 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, with ability for comparison with patient case history and necessary procedural actions;

  • Efficient patient-centered multiple symptoms treatment management;

What is Autonomic Nervous System (ANS)

The autonomic nervous system (ANS) regulates physiologic processes, such as blood pressure, heart rate, body temperature, digestion, metabolism, fluid and electrolyte balance, sweating, urination, defecation, sexual response, and other processes. 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 either the sympathetic or parasympathetic system, although they may receive input from both; occasionally, functions are reciprocal (e.g., sympathetic input 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. Less immediately-life-preserving functions (e.g., digestion, renal filtration) are decreased.

The parasympathetic nervous system is anabolic; it conserves and restores. Gastrointestinal secretions and motility (including evacuation) are stimulated, heart rate is slowed, 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 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 important tasks it is performing. 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. TopDocDX 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 to 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 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.


Cardiac Autonomic Testing Benefits

Cardiac Autonomic Testing 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.

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.

TopDocDX 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

How Is the Test Performed?

Have you recently been informed by that your hospital or clinic should begin administering ANS tests? Are you aware of healthcare guidelines that will require a care path for your patients? If so, it is very likely you have many questions or reservations regarding a new procedure that you are unfamiliar with. However, don't let simple confusion or misunderstanding inhibit you from doing what is best for the health of your patients. The Autonomic Nervous System (ANS), test is designed to best evaluate your patient's bodily functions and plays a significant role in investigating those who suffer from various diseases. There are no invasive or potentially harmful procedures involved, and often a single exam lasts less than a half hour. The can be performed by an MA and a comprehensive report is interpreted.

The test involves four separate procedures, each of which is designed to determine a particular aspect of your patient's ANS function. The four portions are:


  • Resting Phase:
    Heart Rate Variability (HRV) analysis combined with beat-to-beat blood pressure is measured to obtain a baseline of how the autonomic system is functioning during the resting phase.

  • Deep (Metronomic) Breathing Test:
    Heart Rate Variability combined with beat-to-beat blood pressure is measured and monitored during Deep Breathing. Additional comparisons are made to determine the changes during Deep Breathing from the baseline and the baroreflex response.

  • Valsalva Test:
    Heart Rate Variability combined with beat-to-beat blood pressure is measured during Valsalva Maneuver. Additional monitoring and comparisons are obtained to determine the change from the baseline in comparison with the Valsalva maneuver.

  • Standing or Tilt Test:
    Heart Rate Variability coupled with beat-to-beat blood pressure is monitored and measured during Standing/Tilt, and changes are compared with the baseline.

The data obtained from the ANS test evaluates the Parasympathetic (rest and digest) and the Sympathetic (fight, flight response) system, and entire ANS system balance.

Obtaining objective data on the parasympathetic and sympathetic component of the ANS can pinpoint health risks such as sudden death, silent heart attacks, syncope, hypertension and other hidden diseases; likewise, beat-to-beat blood pressure under various conditions can be used to test adrenergic functions for conditions like orthostatic hypotension (OH). OH is widely known to be a consequence of chronic diabetes frequently found amongst the elderly population. Since many OH symptoms can be difficult to trace - impaired concentration, fatigue, etc. - ANS testing can fill this void and bring these problems to light sooner.

If you are still uncertain as to whether ANS testing should be an intricate part of patient care, take the time to consider the investment versus potential reward. Many victims of diabetes and other debilitating diseases have sought out hospitals renowned for their examination of the autonomic nervous system. Your patients depend on you to provide them with the best possible health care. Recent developments in healthcare require you to provide patient education as well as the care path for improving patient health; the ANS test helps you to do both. The amount of information that a single ANS test can provide in just 12 minutes may very well save the life of an ill, elderly or seemingly healthy person. The use of technology now offers a fast, simple, and effective way to test patients for multiple illnesses and allows you to provide improved patient care and maximize the use of your professional time with each patient.

The TopDocDX Combo Pro system is a Class II medical device that is US FDA 510(K) cleared.

TopDocDX Combo Pro testing procedure is covered by the most major insurance providers.


Non-Invasive, Painless, Preventative Testing,  to

Prevent Possible Life Threatening Conditions From Before They Are A Threat

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