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Autonomic Nervous System Testing – Ewing’s Test for POTS & Dysautonomia
Reveal the Hidden Cause Behind Fatigue, Dizziness, and Heart Palpitations
Autonomic Nervous System Testing using Ewing’s Test helps identify problems that routine heart tests often miss. It examines how the autonomic nervous system controls heart rate, blood pressure, and the body’s response to stress. Many people continue to feel tired, dizzy, or experience heart palpitations even when standard test results appear normal.
In many cases, these symptoms are caused by an imbalance in the autonomic nervous system, a condition known as dysautonomia.
When the ANS is not working properly, it is called dysautonomia. It can affect your daily life. It often happens along with POTS, chronic fatigue syndrome, autoimmune disease, long COVID, and diabetes.
To check how your nervous system is working, we offer the Ewing’s Test Battery. It is a group of simple tests. These tests do not require surgery. They measure how your body reacts to stress. They look at both the fight-or-flight response and the rest-and-digest response.
What Is Ewing’s Test?
Autonomic Nervous System Testing evaluates how well your body manages automatic functions that you do not consciously control. These include heart rate, blood pressure, breathing patterns, and blood flow. When this system is not working properly, even small physical or emotional stressors can trigger uncomfortable symptoms.
One of the most trusted methods for this evaluation is Ewing’s Test, developed by neurologist Dr. David Ewing. It is a non-invasive and well-established approach used worldwide in both clinical practice and research.
Understanding Ewing’s Test for POTS and Dysautonomia Diagnosis
Developed by Dr. David Ewing, this battery of tests is considered a gold standard in autonomic nervous system evaluation. Over time, it has become widely used in both clinical and research settings to detect early signs of autonomic dysfunction and to monitor progression or recovery. At our center, the Ewing’s Test is performed in a quiet, controlled environment to ensure accuracy and reliability. During the assessment, four core maneuvers are conducted, each offering a detailed window into how effectively your autonomic system adapts to stress and physiological change. Together, these components provide a comprehensive picture of autonomic function.
1. Deep Breathing Test
During Ewing’s Test, you will breathe slowly and evenly—about six breaths per minute—while we continuously monitor your heart rate. In a healthy nervous system, the heart rate naturally rises with inhalation and falls with exhalation, a phenomenon known as respiratory sinus arrhythmia. This breathing maneuver specifically evaluates parasympathetic tone by measuring how effectively your heart rate responds to controlled, paced breathing. Ideally, a healthy autonomic system demonstrates clear variability between inhalation and exhalation. However, blunted variability may indicate parasympathetic dysfunction and reduced autonomic adaptability.
2. Valsalva Maneuver
You’ll be asked to blow into a closed system (like a syringe or mouthpiece) for 15 seconds, simulating a strong exhalation against resistance. This challenges both sympathetic and parasympathetic branches and helps evaluate baroreflex sensitivity—your body’s ability to stabilize blood pressure and heart rate under stress.
3. Orthostatic (Tilt) Test
Closely related to the Orthostatic Tilt Test, this test checks the 30:15 ratio, which measures how your heart rate changes in the first few seconds after you stand up. It shows how your body’s nervous system responds when your position changes. To measure this, we look at your heart rate at 15 seconds and 30 seconds after standing. By comparing these two readings, we calculate the 30:15 ratio, which helps us understand how quickly and effectively your autonomic nervous system adjusts when you move from sitting or lying down to standing.
4. 30:15 Ratio (Heart Rate Response to Standing)
Closely related to the Orthostatic Tilt Test, this test checks the 30:15 ratio, which measures how your heart rate changes in the first few seconds after you stand up. It shows how your body’s nervous system responds when your position changes. To measure this, we look at your heart rate at 15 seconds and 30 seconds after standing. By comparing these two readings, we calculate the 30:15 ratio, which helps us understand how quickly and effectively your autonomic nervous system adjusts when you move from sitting or lying down to standing.
Ewing’s Test Enhanced by Kubios HRV Scientific Analysis
To improve the accuracy of these tests, we use Kubios HRV, it is trusted by leading medical centers worldwide. This software helps us study heart rate variability (HRV) in detail. It looks at changes in heart rhythm over time. It also measures different patterns in the data.
These results help us understand the balance between the fight-or-flight and rest-and-digest systems. They also help us track recovery. In addition, they allow us to find small problems that other tools may miss.
Through Kubios, we assess:
- Time-domain and frequency-domain HRV parameters (like RMSSD, SDNN, LF/HF ratio)
- Baroreflex sensitivity—an important biomarker of cardiovascular resilience
- Poincaré plots and nonlinear metrics—for visualizing patterns of dysfunction
- Kubios ANS Index—a summary of your autonomic balance, integrating multiple variables into a single score
Furthermore, Kubios follows rigorous scientific standards and has been cited in over 1,800 peer-reviewed studies. As a result, it ensures that our Ewing’s Test analysis meets the highest levels of clinical accuracy and research-backed reliability.
Why Ewing’s Test Matters for Dysautonomia and POTS
The autonomic nervous system influences:
- Energy levels
- Circulation
- Sleep quality
- Digestion
- Emotional resilience
Early identification of autonomic dysfunction through Ewing’s Test for dysautonomia and POTS allows for personalized, proactive care rather than symptom suppression.
This testing helps us:
- Identify hidden autonomic imbalances
- Personalize hydration, nutrition, and movement plans
- Implement nervous system retraining strategies
- Track recovery with objective biomarkers
If you’ve been told “everything looks normal” but still feel unwell, autonomic nervous system testing may provide the clarity you need.
Schedule your Autonomic Nervous System Evaluation today and take the first step toward healing from the inside out and restoring balance and vitality.
Meet Dr. Cynthia Thaik, MD
Dr. Cynthia Thaik is a board-certified cardiologist who integrates functional medicine into her concierge practice with a specialized focus on cardiovascular and neurovascular optimization.
She devotes one week per month exclusively to functional medicine consultations via telehealth, allowing for deep, unrushed care. During this time, Dr. Thaik works closely with patients seeking transformation, root-cause healing, and individualized strategies grounded in integrative science.
Her approach combines:
- Precision diagnostics
- Advanced cardiovascular expertise
- Compassionate, heart-centered listening
- Extensive patient education
“Cardiovascular consultations and diagnostic services are covered by insurance. Functional medicine services are offered exclusively as concierge, self-pay services”
Schedule Your Telehealth Consultation with Dr. Cynthia
If you’re living with atrial fibrillation and want to explore natural treatment options, Dr. Cynthia is here to help. She provides telehealth consultations to guide you through personalized care plans, addressing lifestyle changes, supplement use, and stress management techniques tailored to your unique health needs.
Dr. Cynthia Thaik will perform a thorough cardiovascular assessment, looking at cardiac function, ruling out structural damage, checking paroxysmal atrial fibrillation symptoms, assessing the adverse effects of hypertension and dietary toxicity (alcohol, caffeine, excessive inflammatory foods), checking for vascular inflammation and endothelial dysfunction, and exploring the impact of stress on arterial tone and the autonomic nervous system regulation of the cardiovascular system.
The patient will have an option to receive individual coaching from a mindfulness instructor. Together, this integrative team approach to Afib will provide the patient with the best opportunity to address the root causes underlying the atrial fibrillation and hopefully restore normal sinus rhythm. As with all health conditions, our goal is to help Afib patients transition from symptoms and disease care to optimal health and wellness – true preventive cardiology.
If you have been diagnosed with Atrial Fibrillation and are looking for natural treatments, Schedule a virtual visit or call for Telehealth Appointment at (818) 842 1410
Frequently Asked Questions
Regular palpitations can be a sign of atrial fibrillation. In some cases, this condition may continue for years without causing immediate harm. However, a consistent increase in heart rate can gradually lead to heart enlargement. As a result, this enlargement becomes a serious hazard that may eventually cause heart failure. Additionally, atrial fibrillation is associated with an increased risk of stroke, because blood clots can form in the heart and travel to the brain.
Without a solid understanding of the causes, it can be hard to definitively put a stop to heart palpitations. However, the treatments mentioned above: reducing stress and intake of stimulants, alcohol, and nicotine, exercising more, and eating a balanced diet, are all good steps forward. If your cardiologist determines that you have a more serious heart condition that may be life-threatening, it will require treatment. There are heart medications which can prevent more serious heart rhythm disorders. However, because of their significant side effects, they are not prescribed lightly. Consequences of misuse can lead to heart attacks, or even sudden death.
Some people experience heart palpitations after eating. While those palpitations may be attributable to an underlying medical condition, it is also possible that the food or beverage that was just consumed is responsible. Sugar can have this effect, particularly on hypoglycemic people. Alcohol is another common influence, particularly among those who have paroxysmal atrial fibrillation (PAF). Foods rich in tyramine or theobromine, such as cheese, red wine, bananas, and especially chocolate (which has both), can increase heart rate and may cause atrial fibrillation.
Actually, no. A more likely cause of heart palpitations is in fact low blood pressure. It is true that medication for high blood pressure can have a side effect of causing palpitations, which may be what is happening when someone with high blood pressure experiences palpitations.