Medical Technologies, Inc.

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Medical Technologies, Inc.
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Autonomic Nervous System And Respiration

• The Future of Medicine!

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Common Questions What is the ANX 3.0 test? The
ANX 3.0 tests are two independent clinical tests
(or studies) designed to determine the ability of
both branches of the autonomic nervous system
(ANS) to respond to and relax from a challenge.
The two branches that make up the ANS are the
sympathetic and parasympathetic (SNS and PSNS,
respectively). The challenges are1) deep
breathing to challenge the PSNS,2) valsalva to
challenge the SNS, and3) standing from a seated
position to challenge both systems. How and why
is the ANX 3.0 different from similar
technologies/procedures? ANSAR is the only
company with the MIT patent rights to incorporate
respiratory activity analysis in with heart rate
variability spectral analysis methodology. How
applicable is the procedure to specific disease
states? Clinical literature substantiating the
efficacy of ANS testing for individuals with many
chronic diseases is available, including
leadership articles recommending ANS function
testing. Are there any special considerations
regarding the use of the device? High risk
patients and patients whose pacemakers may pace
during the study should be carefully
considered.
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ANSARis the ANSwer!

• Autonomic Nervous System Monitoring using
  Respiration
• Real-Time
• Non-Invasive
• Digital
• Reimbursable
• Respiration

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ANSAR Promotes Balance

• Maintain Balance Maintain Health
• How?
• With ANSARs autonomic nervous system
  monitor the ANX 3.0!
• Why?
• ANS monitoring is recommended!
• ANS monitoring improves outcomes!
• The ANX 3.0 makes it easy!
• The ANX 3.0 is automated!

• Balance What?
• Parasympathetics Sympathetics

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What Does ANSAR Offer?
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Significant Clinical Applications!

• Beta-Blocker Responsiveness
• CAN
• DAN
• Cardiomyopathies
• Cardiac Arrhythmias
• Congestive Heart Failure
• Syncope
• Hypertension
• Sleep Apnea
• Asthma

• COPD
• Peripheral Vascular Diseases
• Circulation Problems
• Pain Management
• Neurological Conditions
• Chronic Regional Pain Syndrome
• Anxiety/Stress
• Parkinsons Disease
• Psychological Conditions

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Chronic Disease ? Autonomic Imbalance
Autonomic Imbalance Autonomic Dysfunction
Autonomic Dysfunction ? Peripheral Autonomic
Neuropathy (PAN)
PAN ? (DAN ?) CAN ? Death
Diabetic Autonomic Neuropathy (DAN), only if the
patient is a diabetic
Cardiovascular Autonomic Neuropathy (CAN) no
more heart control

• SO WHAT?
• Autonomic Dysfunction is Asymptomatic
• Autonomic Neuropathy does not happen over night
• Autonomic Neuropathy is too late

SUMMARY Chronic Disease ? Autonomic
Dysfunction ? Autonomic Neuropathy
SO CHRONIC DISEASE IS THE INDICATION AND
JUSTIFICATION FOR TESTING
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Who is Recommending ANS Testing?
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Doctor What Have You Been Using?

• Are you using smart technology?
• Are You Seeing the Whole Picture both ANS
• Branches simultaneously as two specific measures?

Is it time to upgrade?
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Want to know the difference between these tests
and ours?
Cardiac Output
Tilt Studies
EKG
Click to see Q-Sart
Nerve Conduction Velocity
Cardiac Output

• EKG

Stress Test
Vascular Imaging
Tilt Studies

• Q-SART

Event Monitoring Event Monitoring
Sitting Standing Blood Pressure Thermal Studies
More comfortable for your patient Simultaneously measures both branches of the ANS Uses Respiration Standard of Care Augment these tests and revenues with more specific ANS information
Holter Monitor
Event Monitoring
Thermal Studies
Sitting Standing Blood Pressure
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Nerve Conduction Velocity
ANX 3.0
Back

• Measures BOTH Sympathetic and Parasympathetic
  nerves independently and simultaneously
• Measures the effects of the small C fibers or
  autonomic and pain fibers.
• Eliminates guessing, detects autonomic
  dysfunction before neuropathy.
• Chronic disease justifies autonomic function
  testing before end-organ changes.
• Detecting dysfunction before neuropathy enables
  more therapeutic options.
• Shorter-term therapy possible

• Does NOT measure Sympathetic or Parasympathetic
  nerves
• Nerve Conduction Velocity measures the larger
  sensory and motor (AB) fibers
• Assumption small fiber neuropathy progresses at
  the same rate as large fiber neuropathy
• Symptoms must be present to test,
• forcing you to wait for disease or disorder
  to cause end-organ changes
• Neuropathy cannot be healed and leaves few
  therapeutic options
• More likely to require life-long therapy

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Tilt Studies
ANX 3.0
Back

• Measures BOTH Sympathetic and Parasympathetic
  nerves independently and simultaneously
• Ansar also indicates autonomic input to the heart
  to help differentiate neural from cardiac
  dysfunction and neural from vascular dysfunction.
• Ansar can also detect and differentiate
  orthostatsis and syncope and differentiate their
  sub-conditions.
• Monitoring is comfortable, shorter, and typically
  revealing of autonomic symptoms.
• Studies are designed for the office and
  interpretation is automated.
• Chronic disease justifies autonomic function
  testing before end-organ changes.
• Shorter-term therapy possible.

• Measure both Sympathetic and Parasympathetic
  nerves, but uses drugs
• Tilt Studies indicate cardiac function, including
  ANS input.
• Tilt can detect and differentiate orthostasis and
  syncope and differentiate their sub-conditions.
• Studies are uncomfortable, time consuming, and
  often unrevealing of autonomic symptoms.
• Studies are difficult to do in the office and
  require significant training to interpret.
• Symptoms must be present to test, forcing you to
  wait for disease or disorder to cause end-organ
  changes
• More likely to require life-long therapy

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Stress Tests
ANX 3.0

Does NOT measure Sympathetic nerves independently only Parasympathetic nerves Stress Tests indicates cardiac function, including ANS input Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar also indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia
Studies are uncomfortable and often unrevealing of autonomic symptoms Monitoring is comfortable and typically revealing of autonomic symptoms
Symptoms must be present to test, forcing you to wait for end-organ changes Chronic disease justifies autonomic function testing, detect dysfunction before neuropathy, more options for early intervention, before CAN
Low normal ejection fractions are difficult to justify implanted devices Low normal ejection fractions with autonomic indications of depleted parasympathetic protection for the heart can differentiate this patient sub-population
Neuropathy (dead nerves) cannot be healed. Diabetic or Cardiovascular Autonomic Neuropathy (DAN or CAN) leaves few therapeutic options. Bruised nerves are easier to heal. Autonomic Dysfunction precedes DAN or CAN, a time when more options are available.

Back
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EKG
ANX 3.0
Back

Does NOT measure Sympathetic nerves independently only Parasympathetic nerves EKG indicates cardiac function, including ANS input Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia
Test is 60 seconds long at rest only Test is 15 minutes, and includes responses to challenges
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes
Likely to require life-long therapy Shorter-term therapy possible

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Holter Monitor
ANX 3.0
Back

Does NOT measure Sympathetic nerves independently only Parasympathetic nerves Holter Monitoring indicates cardiac function over time, including ANS input Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia.
Qualitative measures of ANS Quantitative measures of ANS
Monitoring is uncontrolled, home-based, and can be cumbersome Monitoring is controlled, office-based, and can be performed by most in only 15 minutes.
Data not immediately available Data immediately available
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes
Likely to require life-long therapy Shorter-term therapy possible

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Event Monitor
ANX 3.0
Back

Does NOT measure Sympathetic nerves independently only Parasympathetic nerves Event Monitoring indicates cardiac function over time, including ANS input Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia
Monitoring is uncontrolled, home-based, and can be cumbersome Monitoring is controlled, office-based, and can be performed by most in only 15 minutes.
Data not immediately available Data immediately available
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes
More likely to require life-long therapy Shorter-term therapy possible

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Ambulatory Blood Pressure
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Ambulatory Blood Pressure indicates BP responses over time, including ANS input Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates autonomic input to BP control to help differentiate neural from cardiovascular dysfunction
Ansar study challenges model the different activities patients experience over time
Studies are home based and data is not immediately available Studies are designed for the office and data is immediately available
BP affected by many factors, including baroreceptor reflex which responds to autonomic input Autonomic function in part controls BP. By the time BP changes autonomic dysfunction may have been present for a long time
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes Hypertension is associated with many chronic diseases
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Cardiac Output
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Cardiac Output measures the output from the heart Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar measures the input to the heart
The only thing between the two measures is the heart
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases
More likely to require surgery or life-long therapy Shorter-term therapy possible, may also avoid surgery
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Vascular Imaging
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Vascular Imaging detects vascular valve dysfunction and vascular insufficiency Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates possible autonomic involvement
Vascular insufficiency can be due to sympathetic nerve or smooth muscle dysfunction, imaging cannot differentiate Ansar can detect sympathetic insufficiency (withdrawal)
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases
More likely to require surgery or life-long therapy Shorter-term therapy possible, may also avoid surgery
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Sitting-Standing Blood Pressure
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Sitting-Standing Blood Pressure can indicate presence of supine hypertension and other abnormal BP changes Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates possible autonomic involvement in supine hypertension and other abnormal BP changes
Ansar study challenges model supine to standing conditions
BP affected by many factors, including baroreceptor reflex which responds to autonomic input Autonomic function in part controls BP. By the time BP changes autonomic dysfunction may have been present for a long time.
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases
Chronic BP disorders do not happen over night, Autonomic Dysfunction typically presents first
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Thermal Studies
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Thermal Studies use sweat patterns over the whole body to determine regional autonomic function Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar indicates systemic autonomic function
Thermal studies are difficult to perfom in the office and uncomfortable for the patient Ansar studies are designed for the office and comfortable
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Chronic disease justifies autonomic function testing before end-organ changes
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Q-SART
ANX 3.0
Back
Does NOT measure Sympathetic or Parasympathetic nerves Q-SART investigates sympathetic and parasympathetic innervation of sweat glands to detect peripheral autonomic neuropathy, using electricity and topical applications of drugs Measures systemic autonomic nerves, BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar investigates sympathetic and parasympathetic innervation of the heart and lungs to detect PAN, DAN, and CAN
Q-SART is difficult to perform in the office and uncomfortable for the patient Ansar studies are designed for the office and are comfortable
Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ change Chronic disease justifies autonomic function testing before end-organ changes
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• Reimbursable Under
• Two CPT codes
• 95921-59
• 95922-59
• FDA Clearance
• Standard of Care
• Non-invasive
• Digital
• Real time

Objective Data
Printable Reports
Possible Therapy
Options
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• Dont forget to ask us about
• Tax Savings under Section 179
• Multiple Financing Options
• Special Promotions
• Warranty Maintenance Plan
• Upcoming Shows Events
• Referral Program

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Thank you for giving us your time. We hope this
presentation has been informative.

• If you have any question concerning this
  demonstration or require any leasing information
  please contact us at 888.883.7804.