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Autonomic & Neurovascular Medicine

The Autonomic & Neurovascular Medicine Unit at St John & St Elizabeth Hopsital provides a highly specialised diagnostic service for a wide variety of autonomic disorders: postural tachycardia syndrome, syncope, orthostatic intolerance, postural hypotension, hyperhidrosis and much more.

Autonomic investigations play a key role in aiding the doctors in the diagnosis of autonomic disorders and are also important in tailoring an individual treatment and management plan.

Our Autonomic & Neurovascular Medicine Consultants


The autonomic nervous system (ANS) is comprised of the sympathetic (fight or flight response) and parasympathetic (rest and digestion) nervous systems. The ANS innervates every end organ in the body: such as skin, heart,  bladder and bowels;  and is very important in the control of bodily functions, such as regulation of sweating, blood pressure, heart rate, digestion and sexual function.  Individuals with autonomic disorders may have many disabling symptoms, such as lightheadedness or fainting, constipation, bladder control problems, and sexual dysfunction.

The Autonomic & Neurovascular Medicine Unit provides a highly specialised diagnostic service for a wide variety of autonomic disorders. We have two state of the art laboratories incorporating the latest advances in non-invasive technology. Autonomic investigations play a key role in aiding the doctors in the diagnosis of autonomic disorders and are also important in tailoring an individual treatment and management plan. The team aim to help people with autonomic symptoms, some of which are multiple and complex, to successfully manage their daily lives.

Autonomic dysfunction is usually a multi-system disorder and we work closely with other departments within St John & St Elizabeth Hospital and other leading consultants: including Hypermobility Unit, Cardiology, Imaging, Physiotherapy, Gastroenterology, Urology, Gynaecology and Immunology.

Autonomics team

Mr Michael Peche – Lead Clinical Autonomic Scientist & Deputy Service Manager

Miss Kiran Sheri – Senior Clinical Autonomic Scientist

Miss Britney Powell – Clinical Autonomic Scientist

Miss Seema Maru – Bank Clinical Autonomic Scientist

Miss Vanessa Ponnusamy – Bank Clinical Autonomic Scientist

Conditions treated by the Autonomics team

  • Acute/subacute dysautonomia
  • Amyloidosis (familial and primary)
  • Anhidrosis
  • Autonomic mediated syncope (vasovagal, micturition, cough, swallow and other situational forms, carotid sinus hypersenstivity)
  • Congenital autonomic failure
  • Diabetic autonomic neuropathies
  • Dysreflexia due to spinal cord injury
  • Guillain-Barré syndrome
  • Holmes-Adie syndrome
  • Hyperhidrosis (essential and gustatory)
  • Immune-mediated autonomic neuropathies
  • Orthostatic (postural) hypotension
  • Primary autonomic failure (Pure Autonomic Failure, Multiple system atrophy)
  • Pheochromocytoma
  • Postural tachycardia syndrome (PoTS)

Autonomic diagnostic investigations

Core autonomic diagnostic testing

  • Autonomic function screening tests
  • Plasma Catecholamine blood samples
  • Head up tilt test
  • Liquid meal challenge
  • Modified exercise test
  • 24 hour ambulatory blood pressure monitoring
  • 24 hour continuous heart rate monitoring

Other autonomic diagnostic testing:

  • 24 hour urinary catecholamine samples
  • Acetylcholine alpha 3 nicotinic receptor antibodies
  • Autonomic dysreflexia test
  • Cardiovascular autonomic responses to cervical head and neck movements
  • Cardiovascular autonomic responses to arm movements
  • Cardiovascular autonomic responses to sildenafil
  • Carotid sinus massage
  • Liquid meal challenge with Octreotide
  • Liquid meal challenge with Pyridostigmine
  • Plasma Metaenphrine blood samples

Important information for autonomic testing appointments:

If you have any questions before attending your autonomic testing appointments you can download our patient guide.

Autonomic function tests

For more information on our autonomic function tests please click on the tests below.

Plasma catecholamine / metanephrine blood samples

Head up tilt test

Liquid meal test

Modified exercise test

24hr BP and HR monitoring using the autonomic protocol

Any patients that have been requested for a 24 hour Blood pressure and heart rate monitoring can download our patient guide to find out more information.

A patient speaking to a receptionist

Patient information

Our Hospital is renowned for providing exemplary levels of care across more than 90 services. From orthopaedics, to urology, ENT, as well as a private GP practice and our urgent care centre, Casualty First, our services are led by some of London’s leading Consultants. For more information, and to find a service suitable for your care, find out more about the services that we offer.

Make an enquiry

If you have any questions relating to treatment options or pricing information then get in touch with us by filling out one of our contact boxes or giving us a call on +44 207 806 4060.

Our Appointments Team have a dedicated and caring approach to finding you the earliest appointment possible with the best specialist.

 If you are self-paying you don’t need a referral from your GP for a consultation. You can simply refer yourself* and book an appointment.

If you have medical insurance (e.g. Bupa, Axa PPP, Aviva), you will need to contact your insurer to get authorisation for any treatment and, in most cases, you will require a referral letter from your GP.

If you do not have a GP, then we have an in-house private GP practice that you can use. Alternatively we can suggest the most appropriate course of action for you to take, given your location and individual circumstance.

*Please note – for investigations such as X-rays and MRI’s a referral will be required. However, we may be able to arrange this for you through our on-site private GP.

    Make an enquiry

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