Patients with no heart disease and normal ECG
Syncope is patients with no history of heart disease and a normal ECG is most commonly neurally mediated.
The following investigations should be considered:
- tilt table testing
- carotid massage should be performed in the elderly:
- eliciting a vasovagal event supports the diagnosis of carotid sinus syndrome
- the small risk of causing a stroke in a patient with a carotid bruit or cerebrovascular disease should be weighed against the importance of making a positive diagnosis
- patients with frequent syncope and other somatic symptoms should be referred for a psychiatric assessment
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