Abstract
This chapter begins the rest of the book, in that it turns the readers’ attention from the theoretical and developmental issues behind P&S monitoring and begins the focus of applying P&S monitoring clinically. It is a general overview of the additional information that is available from P&S monitoring and Autonomic Assessment. In this chapter, we describe the data that are collected, what clinical reporting is produced, and how to utilize and interpret the reports. Again, within the theme of an overview, orienting the reader to what will come, these are general interpretation guidelines, the specifics, including disease-specific applications, will come later. Included in this chapter is how P&S monitoring may be synergistic with other tests. In general, two questions are asked: are the sympathetics managed, and are the parasympathetics balanced, relative to the sympathetics, to promote health and minimize risk? The chapter starts with a general answer to the inevitable “So what?” response, which is more specifically answered throughout the remainder of the book in relation to specific diseases.
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References
Umetani K, Singer DH, McCraty R, Atkinson M. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol. 1998;31(3):593–601.
Arora RR, Ghosh Dastidar S, Colombo J. Autonomic balance is associated with decreased morbidity. American Autonomic Society, 17th International Symposium, Kauai, 29 Oct – 1 Nov, 2008.
Waheed A, Ali MA, Jurivich DA, et al. Gender differences in longevity and autonomic function. Presented at the Geriatric Medicine Society Meeting, Chicago, 3–7 May, 2006.
Vinik AI, Maser RE, Nakave AA. Diabetic cardiovascular autonomic nerve dysfunction. US Endocrine Disease. 2007;2:2–9.
Vinik A, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.
DePace NL, Mears JP, Yayac M, Colombo J. Cardiac autonomic testing and diagnosing heart disease. “A clinical perspective.” In Press, 2014.
DePace NL, Mears JP, Yayac M, Colombo J. Cardiac autonomic testing and treating heart disease. “A clinical perspective.” In Press, 2014.
Bloomfield DM, Kaufman ES, Bigger Jr JT, Fleiss J, Rolnitzky L, Steinman R. Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. Am Heart J. 1997;134(2 Pt 1):316–20.
Malik M. The Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65.
Malik M, Task Force of the European Society of Cardiology, North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354–81.
Tobias H, Vinitsky A, Bulgarelli RJ, Ghosh-Dastidar S, Colombo J. Autonomic nervous system monitoring of patients with excess parasympathetic responses to sympathetic challenges – clinical observations. US Neurol. 2010;5(2):62–6.
Arora RR, Bulgarelli RJ, Hearyman M, Ghosh Dastidar S, Colombo J. Carvedilol reverses standing parasympathetic excess in non-diabetics. St. Thomas: American Autonomic Society; 2009.
CPT Code 95921 – testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio. CPT 2013, Standard edition.
CPT Code 95922 – 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.
CPT Code 95924 – combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt.
CPT Code 95943 – simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced (deep) breathing, Valsalva maneuvers, and head-up postural change.
CPT Code 93040 – rhythm ECG, one to three leads, with interpretation.
Sandroni P, Opfer-Gehrking TL, Singer W, Low PA. Pyridostigmine for treatment of neurogenic orthostatic hypotension: a follow up survey study. Clin Auton Res. 2005;15:51–3.
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Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Parasympathetic and Sympathetic Testing. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_6
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DOI: https://doi.org/10.1007/978-3-319-07371-2_6
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