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Patients with no heart disease and normal ECG

Authoring team

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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