What investigations are recommended for a patient with recurrent syncope and no clear diagnosis after initial assessment?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For patients with recurrent syncope and no clear diagnosis after initial assessment, the recommended investigations include a specialist cardiovascular assessment, which involves a detailed history, physical examination, and repeat 12-lead ECG, as well as examination of previous ECG recordings .

If structural heart disease is suspected, appropriate investigations such as cardiac imaging should be undertaken .

Further testing may include investigations for suspected cardiac arrhythmic causes, postural hypotension, or neurally mediated syncope, as directed by the specialist assessment .

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