The diagnostic procedure in patients with the carotid sinus syndrome is carotid sinus massage; this is safe provided that the patient does not have a carotid bruit or a history of cerebrovascular disease. There should be resuscitation equipment available.
The patient is attached to a cardiac monitor and carotid sinus massage is performed for five seconds in the supine and then the upright positions. Symptomatic (pre-)syncope or bradycardia during sinus massage is diagnostic.
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