Syncope: evaluation and management. A review of current approaches to this multifaceted and complex clinical problem.

Syncope is a common but complex medical disorder with a multitude of etiologies, some of which are still not well understood. In a general population, the greatest diagnostic yield is from the history and physical examination. Numerous other diagnostic modalities include Holter monitoring, signal-averaged ECG, cardiac electrophysiology study, and tilt table testing. A defined etiology will not be determined for a large percentage of patients after such an extensive work-up. Management of patients is based on the cause of syncope and is difficult in those patients in whom an etiology cannot be established. The syndrome of neurally mediated syncope is a relatively recently appreciated entity and provides important clinical investigational challenges.